Provider Demographics
NPI:1073767786
Name:LEVIN-GASPARYAN, YELENA (MPT)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:LEVIN-GASPARYAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10854 WYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2652
Mailing Address - Country:US
Mailing Address - Phone:818-207-7581
Mailing Address - Fax:
Practice Address - Street 1:5620 WILBUR AVE STE 103
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1336
Practice Address - Country:US
Practice Address - Phone:818-207-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2022-07-21
Deactivation Date:2014-12-10
Deactivation Code:
Reactivation Date:2017-06-29
Provider Licenses
StateLicense IDTaxonomies
CAPT 23839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist