Provider Demographics
NPI:1992858542
Name:MAGHSOODI, SHANA (PT)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:MAGHSOODI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26072 MERIT CIR
Mailing Address - Street 2:STE 119
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7015
Mailing Address - Country:US
Mailing Address - Phone:949-859-6600
Mailing Address - Fax:949-859-6606
Practice Address - Street 1:369 SAN MIGUEL DR
Practice Address - Street 2:STE 265
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7818
Practice Address - Country:US
Practice Address - Phone:949-644-2022
Practice Address - Fax:949-644-1914
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13590OtherPT LICENSE