MEDICARE: SHAYAN SAFAR DPT, PT

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	299547	CA

General Provider Information

NPI Number	:	1629664834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYAN SAFAR DPT, PT

Provider Business Mailing Address
First Line	:	2226 THREE SPRINGS DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5546
Country	:	US
Telephone Number	:	818-292-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2226 THREE SPRINGS DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5546
Country	:	US
Telephone Number	:	818-292-0010
Fax Number	:

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

Provider Enumeration Date	:	12/12/2020
Last Update Date	:	12/08/2021

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