Provider Demographics
NPI:1558686675
Name:ZIMINA, YELENA IQOREVNA (PT)
Entity Type:Individual
Prefix:MISS
First Name:YELENA
Middle Name:IQOREVNA
Last Name:ZIMINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD STE 1280
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4366
Mailing Address - Country:US
Mailing Address - Phone:818-986-1886
Mailing Address - Fax:818-995-7117
Practice Address - Street 1:16311 VENTURA BLVD STE 1280
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4366
Practice Address - Country:US
Practice Address - Phone:818-986-1886
Practice Address - Fax:818-995-7117
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist