Provider Demographics
NPI:1861248700
Name:PETROSYAN PHYSICAL THERAPY, APC
Entity type:Organization
Organization Name:PETROSYAN PHYSICAL THERAPY, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:818-426-5616
Mailing Address - Street 1:921 VERDUGO CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1535
Mailing Address - Country:US
Mailing Address - Phone:818-426-5616
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 340
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4017
Practice Address - Country:US
Practice Address - Phone:818-426-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy