Provider Demographics
NPI:1649354523
Name:GHAZINOURI, ROYA (PT)
Entity type:Individual
Prefix:MS
First Name:ROYA
Middle Name:
Last Name:GHAZINOURI
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 1:19 GARDEN ST
Mailing Address - Street 2:APT 47
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3622
Mailing Address - Country:US
Mailing Address - Phone:917-648-0486
Mailing Address - Fax:
Practice Address - Street 1:19 GARDEN ST
Practice Address - Street 2:APT 47
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3622
Practice Address - Country:US
Practice Address - Phone:917-648-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist