Provider Demographics
NPI:1225096019
Name:ZABALA, CHARLES J (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:ZABALA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7330 FOSTER BRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2016
Mailing Address - Country:US
Mailing Address - Phone:323-683-3595
Mailing Address - Fax:323-843-9567
Practice Address - Street 1:4060 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3717
Practice Address - Country:US
Practice Address - Phone:562-989-6516
Practice Address - Fax:562-989-6516
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist