Healthcare Provider Details

I. General information

NPI: 1801679550
Provider Name (Legal Business Name): VITA PT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTRAL AVE STE 313
GLENDALE CA
91202-2937
US

IV. Provider business mailing address

1010 N CENTRAL AVE STE 313
GLENDALE CA
91202-2937
US

V. Phone/Fax

Practice location:
  • Phone: 424-777-7377
  • Fax: 424-316-3377
Mailing address:
  • Phone: 424-777-7377
  • Fax: 424-316-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVIT NAZARYAN
Title or Position: CEO
Credential:
Phone: 424-777-7377