Healthcare Provider Details

I. General information

NPI: 1063285179
Provider Name (Legal Business Name): SHANT ALEXANDER MINASSIAN PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 OCEAN VIEW BLVD STE 350
LA CANADA FLINTRIDGE CA
91011-1409
US

IV. Provider business mailing address

10630 MCCLEMONT AVE
TUJUNGA CA
91042-1704
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax:
Mailing address:
  • Phone: 818-859-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: