Provider Demographics
NPI:1801679550
Name:VITA PT INC
Entity type:Organization
Organization Name:VITA PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVIT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-777-7377
Mailing Address - Street 1:1010 N CENTRAL AVE STE 313
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2937
Mailing Address - Country:US
Mailing Address - Phone:424-777-7377
Mailing Address - Fax:424-316-3377
Practice Address - Street 1:1010 N CENTRAL AVE STE 313
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2937
Practice Address - Country:US
Practice Address - Phone:424-777-7377
Practice Address - Fax:424-316-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy