Healthcare Provider Details

I. General information

NPI: 1477161255
Provider Name (Legal Business Name): AZAR PT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19055 FRIAR ST
TARZANA CA
91335-6734
US

IV. Provider business mailing address

19055 FRIAR ST
TARZANA CA
91335-6734
US

V. Phone/Fax

Practice location:
  • Phone: 818-302-9296
  • Fax:
Mailing address:
  • Phone: 818-302-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AZAR NOORAFROUZ
Title or Position: RPT
Credential: DPT
Phone: 818-302-9296