Provider Demographics
NPI:1316061781
Name:FARROKHI, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FARROKHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SOUTH RAYMOND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-403-1444
Mailing Address - Fax:626-403-1448
Practice Address - Street 1:630 SOUTH RAYMOND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-403-1444
Practice Address - Fax:626-403-1448
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist