Provider Demographics
NPI:1043095854
Name:KIYUNA, ZACH (PTA)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:KIYUNA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8718
Mailing Address - Country:US
Mailing Address - Phone:458-210-2940
Mailing Address - Fax:
Practice Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8718
Practice Address - Country:US
Practice Address - Phone:458-210-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10218225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant