MEDICARE: REFORM 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	:	1740145788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFORM PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	4419 VAN NUYS BLVD STE 416
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2910
Country	:	US
Telephone Number	:	818-922-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4419 VAN NUYS BLVD STE 416
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2910
Country	:	US
Telephone Number	:	818-922-2040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNA RAFAELIAN
Credential	:
Telephone Number	:	818-922-2040

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	04/13/2026

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