Provider Demographics
NPI:1194016329
Name:SHABAT, DAVID V
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:V
Last Name:SHABAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1815
Mailing Address - Country:US
Mailing Address - Phone:818-832-0411
Mailing Address - Fax:
Practice Address - Street 1:11165 SEPULVEDA BLVD
Practice Address - Street 2:SPA BLDG., PT DEP'T
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1113
Practice Address - Country:US
Practice Address - Phone:818-837-5732
Practice Address - Fax:818-837-2709
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5557225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant