MEDICARE: ADVANCE THERAPY PHYSICAL THERAPY CLINIC, 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	PT25149	CA

General Provider Information

NPI Number	:	1538192695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE THERAPY PHYSICAL THERAPY CLINIC, INC

Provider Business Mailing Address
First Line	:	1415 E COLORADO ST STE 212
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 E COLORADO ST STE 212
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1541
Country	:	US
Telephone Number	:	818-240-5512
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SAHAKYAN MARIAM
Credential	:
Telephone Number	:	818-240-5512

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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