MEDICARE: NICOLE ARIANA PETROUSIAN 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	208100000X	Physical Medicine & Rehabilitation Physician	PT294829	CA

General Provider Information

NPI Number	:	1982196911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ARIANA PETROUSIAN PT, DPT

Provider Business Mailing Address
First Line	:	2001 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2932
Country	:	US
Telephone Number	:	818-953-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2932
Country	:	US
Telephone Number	:	818-953-4444
Fax Number	:

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

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	06/05/2018

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