Provider Demographics
NPI:1316242183
Name:NIKBAKHT, SEPEEHDEH (DPT)
Entity type:Individual
Prefix:
First Name:SEPEEHDEH
Middle Name:
Last Name:NIKBAKHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6137
Mailing Address - Country:US
Mailing Address - Phone:408-354-2223
Mailing Address - Fax:408-354-2228
Practice Address - Street 1:291 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6137
Practice Address - Country:US
Practice Address - Phone:408-354-2223
Practice Address - Fax:408-354-2228
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37390OtherPHYSICAL THERAPY LICENSE