Healthcare Provider Details

I. General information

NPI: 1689784944
Provider Name (Legal Business Name): MAHSA MODARRES SABZEVARI MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 YGNACIO VALLEY RD SUITE 200
WALNUT CREEK CA
94596-3871
US

IV. Provider business mailing address

4188 PARK BLVD APT 4
OAKLAND CA
94602-1255
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-6778
  • Fax: 925-945-0389
Mailing address:
  • Phone: 312-515-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT33670
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT33670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: