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General NPI Number Information
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NPI Number | 1184384612
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY 1ST REHABILITATION WELLNESS A PROFESSIONAL CORPOR
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Dates
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Enumeration Date | 12/24/2021
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1934 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3957
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Country | US
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Telephone | 818-561-7707
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Fax | 213-724-0277
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Provider Business Mailing Address
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Address Line | 1934 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3957
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Country | US
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Telephone | 818-561-7707
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARDAVAN MAKAREMI
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Credential | DPT
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Telephone | 818-799-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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