Provider Demographics
NPI:1689485666
Name:PHYSICAL THERAPY & SPORTS MEDICINE
Entity type:Organization
Organization Name:PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-356-4540
Mailing Address - Street 1:18517 MARBELLA LANE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:804-356-4540
Mailing Address - Fax:
Practice Address - Street 1:19932 VENTURA BLVD.
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:804-356-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy