MEDICARE: VERSA PHYSICAL THERAPY, INC

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

General Provider Information

NPI Number	:	1396462446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSA PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	1030 S GLENDALE AVE STE 404
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2866
Country	:	US
Telephone Number	:	818-245-6364
Fax Number	:	818-350-1119

Provider Business Practice Location Address
First Line	:	1030 S GLENDALE AVE STE 404
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2866
Country	:	US
Telephone Number	:	818-245-6364
Fax Number	:	818-350-1119

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY/OWNER
Name	:	LALAGEH YAGHOUBI
Credential	:	PT, DPT
Telephone Number	:	818-245-6364

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	04/08/2026

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Directions to “VERSA PHYSICAL THERAPY, INC ” Practice Location

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