=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790043032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINA HAMIDI RPT PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2012
-----------------------------------------------------
Last Update Date | 09/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 E COLORADO ST UNIT 250
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-246-5100
-----------------------------------------------------
Fax | 818-246-3604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 E COLORADO ST UNIT 250
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-246-5100
-----------------------------------------------------
Fax | 818-246-3604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SINA HAMIDI
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 818-486-5496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | PT9766
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------