Provider Demographics
NPI:1114530953
Name:ZAVALA, BOBBI LEA (PTA)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:LEA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MARSHA DR
Mailing Address - Street 2:
Mailing Address - City:CRESSONA
Mailing Address - State:PA
Mailing Address - Zip Code:17929-1500
Mailing Address - Country:US
Mailing Address - Phone:570-527-8865
Mailing Address - Fax:
Practice Address - Street 1:544 N PENRYN RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-8562
Practice Address - Country:US
Practice Address - Phone:570-527-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI005214225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant