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General NPI Number Information
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NPI Number | 1902811755
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Entity Type | Organization
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Legal Business Name | MID VALLEY PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD SUITE # 305
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City | ENCINO
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State | CA
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Zip | 91436-1914
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Country | US
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Telephone | 818-259-3598
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Fax | 818-992-5354
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Provider Business Mailing Address
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Address Line | 5824 MCDONIE AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-5501
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Country | US
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Telephone | 818-992-5351
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Fax | 818-992-5354
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Authorized Official
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Title or Position | OWNER
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Name | SHEIDA RAHIMIAN
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Credential | RPT
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Telephone | 818-259-3598
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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 | PT18903
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License Number State | CA
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