Provider Demographics
NPI:1538360490
Name:SHAHAMATI, FARIMA (PT,OMD)
Entity type:Individual
Prefix:
First Name:FARIMA
Middle Name:
Last Name:SHAHAMATI
Suffix:
Gender:F
Credentials:PT,OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 S BEVERLY GLEN BLVD
Mailing Address - Street 2:#117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6048
Mailing Address - Country:US
Mailing Address - Phone:310-203-9292
Mailing Address - Fax:310-201-5018
Practice Address - Street 1:7040 TRASK AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2622
Practice Address - Country:US
Practice Address - Phone:714-900-1439
Practice Address - Fax:714-890-6012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3471171100000X
CAPT11796225100000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner