Provider Demographics
NPI:1386270775
Name:PARANTAR, JOAN (PT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PARANTAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:ADAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8022 VIA VERONA
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1533
Mailing Address - Country:US
Mailing Address - Phone:818-370-6444
Mailing Address - Fax:
Practice Address - Street 1:8022 VIA VERONA
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1533
Practice Address - Country:US
Practice Address - Phone:818-370-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35963Medicaid