Healthcare Provider Details

I. General information

NPI: 1386882447
Provider Name (Legal Business Name): LAX REHABILITATION CENTER AND PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 S SEPULVEDA BLVD STE 104
LOS ANGELES CA
90045-4849
US

IV. Provider business mailing address

9100 S SEPULVEDA BLVD STE 104
LOS ANGELES CA
90045-4849
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-9999
  • Fax: 310-670-9994
Mailing address:
  • Phone: 310-670-9999
  • Fax: 310-670-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ARAGHI
Title or Position: PRESIDENT
Credential:
Phone: 310-670-9999