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General NPI Number Information
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NPI Number | 1649707464
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Entity Type | Organization
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Legal Business Name | IGN PHYSIOTHERAPY INC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 2123 FOOTHILL BLVD SUITE D
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City | LA VERNE
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State | CA
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Zip | 91750-2954
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Country | US
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Telephone | 818-415-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 FOOTHILL BLVD SUITE 101
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City | LA VERNE
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State | CA
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Zip | 91750-3451
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Country | US
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Telephone | 818-415-1522
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Fax |
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | MR. EMIL ARMEN NAZARYAN
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Credential |
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Telephone | 818-415-1522
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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 | PT33250
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License Number State | CA
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