Provider Demographics
NPI:1588114052
Name:NEW AGE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:NEW AGE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORE OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-405-8698
Mailing Address - Street 1:512 W STOCKER ST APT 6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3523
Mailing Address - Country:US
Mailing Address - Phone:818-502-2527
Mailing Address - Fax:818-502-2055
Practice Address - Street 1:6221 WILSHIRE BLVD STE 620
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5215
Practice Address - Country:US
Practice Address - Phone:323-592-3534
Practice Address - Fax:323-978-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 41466261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy