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General NPI Number Information
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NPI Number | 1679299903
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Entity Type | Organization
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Legal Business Name | NOVA PHYSICAL THERAPY PROF. CORP.
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 4795 VINELAND AVE STE E
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3546
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Country | US
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Telephone | 818-639-3402
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Fax | 818-639-3425
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Provider Business Mailing Address
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Address Line | 4795 VINELAND AVE STE B
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3546
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Country | US
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Telephone | 818-639-3402
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Fax | 818-639-3425
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPAN MKRTCHYAN
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Credential | PT, DPT
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Telephone | 818-639-3402
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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 |
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License Number State |
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