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General NPI Number Information
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NPI Number | 1215464185
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Entity Type | Organization
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Legal Business Name | REVAMP PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 805 E BROADWAY STE A
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City | GLENDALE
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State | CA
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Zip | 91205-4527
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Country | US
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Telephone | 818-254-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 805 E BROADWAY STE A
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City | GLENDALE
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State | CA
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Zip | 91205-4527
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Country | US
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Telephone | 818-254-8792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BABKEN SARKISSIAN
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Credential | DPT
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Telephone | 818-254-8792
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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 | PT291985
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License Number State | CA
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