Healthcare Provider Details

I. General information

NPI: 1942965694
Provider Name (Legal Business Name): KARINE YETERIAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 11/07/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CENTRAL AVE STE 350
GLENDALE CA
91203-3926
US

IV. Provider business mailing address

2095 MINORU DR
ALTADENA CA
91001-3417
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-5012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: