Provider Demographics
NPI:1649707464
Name:IGN PHYSIOTHERAPY INC
Entity type:Organization
Organization Name:IGN PHYSIOTHERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:ARMEN
Authorized Official - Last Name:NAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-415-1522
Mailing Address - Street 1:1407 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3451
Mailing Address - Country:US
Mailing Address - Phone:818-415-1522
Mailing Address - Fax:
Practice Address - Street 1:2123 FOOTHILL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2954
Practice Address - Country:US
Practice Address - Phone:818-415-1522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty