Provider Demographics
NPI:1811917347
Name:KOREN, ARIE (RPT)
Entity type:Individual
Prefix:MR
First Name:ARIE
Middle Name:
Last Name:KOREN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 BEEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4402
Mailing Address - Country:US
Mailing Address - Phone:818-999-2320
Mailing Address - Fax:818-999-2830
Practice Address - Street 1:6026 BEEMAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4402
Practice Address - Country:US
Practice Address - Phone:818-999-2320
Practice Address - Fax:818-999-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17713OtherSTATE LICENSE