Provider Demographics
NPI:1184777443
Name:MEDSTAR PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MEDSTAR PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEDIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-624-0766
Mailing Address - Street 1:980 ATLANTIC AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4570
Mailing Address - Country:US
Mailing Address - Phone:562-624-0766
Mailing Address - Fax:562-624-1150
Practice Address - Street 1:980 ATLANTIC AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4570
Practice Address - Country:US
Practice Address - Phone:562-624-0766
Practice Address - Fax:562-624-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 12100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty