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General NPI Number Information
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NPI Number | 1598583171
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Entity Type | Organization
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Legal Business Name | THRIVE AND SHINE THERAPY
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 3251 W 6TH ST STE 401
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City | LOS ANGELES
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State | CA
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Zip | 90020-5029
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Country | US
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Telephone | 310-954-9614
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Fax |
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Provider Business Mailing Address
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Address Line | 3251 W 6TH ST STE 401
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City | LOS ANGELES
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State | CA
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Zip | 90020-5029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | NEDA REZAPOOR
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Credential |
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Telephone | 310-866-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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