Provider Demographics
NPI:1063577047
Name:REZA NABAVI, P.T., P.C.
Entity type:Organization
Organization Name:REZA NABAVI, P.T., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAVI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-270-5555
Mailing Address - Street 1:PO BOX 851888
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1888
Mailing Address - Country:US
Mailing Address - Phone:972-270-5555
Mailing Address - Fax:972-270-7071
Practice Address - Street 1:2696 N GALLOWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6362
Practice Address - Country:US
Practice Address - Phone:972-270-5555
Practice Address - Fax:972-270-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00874XMedicare PIN