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General NPI Number Information
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NPI Number | 1033438379
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Entity Type | Organization
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Legal Business Name | SHAFA PHYSICAL THERAPY, SPORT INJURY AND REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 11819 WILSHIRE BLVD SUITE # 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-6619
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Country | US
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Telephone | 310-777-7594
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6597
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-6597
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Country | US
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Telephone | 310-777-7594
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Fax |
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Authorized Official
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Title or Position | PT
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Name | DORIS SHADROOZ
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Credential |
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Telephone | 310-552-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 34634
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License Number State | CA
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