Individual provider Active NPI

Laura Nazaryan, D.P.T.

  • Physical Therapist
  • La Verne, CA
National Provider Identifier
1700906138
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
33250 Issued in CA
Practice address
2123 Foothill Blvd Ste D
La Verne, CA 91750
Phone
(909) 596-9696
Fax
(909) 596-9698
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 33250 CA Primary

Addresses

Primary practice location

2123 Foothill Blvd Ste D
La Verne, CA 91750

Mailing address

1407 Foothill Blvd # 101
La Verne, CA 91750-3451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180208000457 CA Practitioner - Physical Therapist in Private Practice 6406116680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ign Physiotherapy IncGroup PAC ID 6103186440, 3 clinicians

Practice addresses (Care Compare)

2123 Foothill Blvd
Suite D
La Verne, CA 91750-2954
Phone (818) 415-1522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33250CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Ign Physiotherapy Inc Physical Therapist CurrentSince Jan 8, 2018 Accepting new patients

Locations

2123 Foothill Blvd
Ste D
La Verne, CA 91750
Phone (818) 415-1522

1407 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-3577

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1700906138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 FOOTHILL BLVD # 101",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 FOOTHILL BLVD STE D",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "91750",
            "telephone_number": "909-596-9696",
            "fax_number": "909-596-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAZARYAN",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "33250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Verne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.