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General NPI Number Information
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NPI Number | 1063285179
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Entity Type | Individual
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Provider Name | SHANT ALEXANDER MINASSIAN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 719 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90401-2601
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Country | US
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Telephone | 310-260-9039
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Fax |
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Provider Business Mailing Address
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Address Line | 6829 NORTHFORD DR
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City | TUJUNGA
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State | CA
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Zip | 91042-3230
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Country | US
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Telephone | 818-852-4501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT304084
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License Number State | CA
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