Basic Information
| Provider Information | |||||||||
| NPI: | 1245656032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SADRPOUR | ||||||||
| FirstName: | SHAHRZAD | ||||||||
| MiddleName: | SOPHIA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| OtherLastName: | SADRPOUR | ||||||||
| OtherFirstName: | SHAHRZAD | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8717 VENICE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900343216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377115 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8717 VENICE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900343216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103377115 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | PT 41135 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.