MEDICARE: STEPAN MKRTCHYAN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	301432	CA

General Provider Information

NPI Number	:	1093467607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPAN MKRTCHYAN PT, DPT

Provider Business Mailing Address
First Line	:	4795 VINELAND AVE STE E
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3546
Country	:	US
Telephone Number	:	818-639-3402
Fax Number	:	818-639-3425

Provider Business Practice Location Address
First Line	:	4795 VINELAND AVE STE E
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3546
Country	:	US
Telephone Number	:	818-639-3402
Fax Number	:	818-639-3425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	04/17/2024

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