Healthcare Provider Details

I. General information

NPI: 1134937139
Provider Name (Legal Business Name): TATIANA RATAVOSIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 WILSHIRE BLVD STE 600
LOS ANGELES CA
90048-5521
US

IV. Provider business mailing address

10010 TUJUNGA CANYON BLVD APT D
TUJUNGA CA
91042-2890
US

V. Phone/Fax

Practice location:
  • Phone: 877-757-8353
  • Fax:
Mailing address:
  • Phone: 818-530-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberOR242722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: