Healthcare Provider Details

I. General information

NPI: 1508492521
Provider Name (Legal Business Name): SORAYA ROUDSARI PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 LANCASTER AVE
LOS ANGELES CA
90033-1503
US

IV. Provider business mailing address

2583 LANCASTER AVE
LOS ANGELES CA
90033-1503
US

V. Phone/Fax

Practice location:
  • Phone: 408-512-9157
  • Fax:
Mailing address:
  • Phone: 408-512-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SORAYA AHMADI-NIA ROUDSARI
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 408-512-9157