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General NPI Number Information
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NPI Number | 1588114052
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Entity Type | Organization
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Legal Business Name | NEW AGE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6221 WILSHIRE BLVD STE 620
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City | LOS ANGELES
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State | CA
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Zip | 90048-5215
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Country | US
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Telephone | 323-592-3534
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Fax | 323-978-5988
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Provider Business Mailing Address
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Address Line | 512 W STOCKER ST APT 6
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City | GLENDALE
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State | CA
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Zip | 91202-3523
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Country | US
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Telephone | 818-502-2527
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Fax | 818-502-2055
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Authorized Official
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Title or Position | DOCTORE OF PHYSICAL THERAPY
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Name | DR. MEHDI EBRAHIMI
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Credential | DPT
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Telephone | 818-405-8698
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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 | PT 41466
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License Number State | CA
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