Healthcare Provider Details

I. General information

NPI: 1235317587
Provider Name (Legal Business Name): ALLEN MINASSIAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 FOOTHILL BLVD SUITE D
LA CANADA FLINTRIDGE CA
91011-2107
US

IV. Provider business mailing address

1434 FOOTHILL BLVD SUITE D
LA CANADA FLINTRIDGE CA
91011-2107
US

V. Phone/Fax

Practice location:
  • Phone: 818-864-6479
  • Fax: 818-864-6429
Mailing address:
  • Phone: 818-864-6479
  • Fax: 818-864-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: