Healthcare Provider Details

I. General information

NPI: 1396508396
Provider Name (Legal Business Name): FULL MOTION PHYSICAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S FAIR OAKS AVE STE 216
PASADENA CA
91105-2082
US

IV. Provider business mailing address

107 S FAIR OAKS AVE STE 216
PASADENA CA
91105-2082
US

V. Phone/Fax

Practice location:
  • Phone: 818-425-7785
  • Fax:
Mailing address:
  • Phone: 818-425-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASTGIK KOSSHKARYAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-425-7785