Provider Demographics
NPI:1578879516
Name:PEVNICK, ZACHARY DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DAVID
Last Name:PEVNICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12655 W JEFFERSON BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7008
Mailing Address - Country:US
Mailing Address - Phone:310-907-9215
Mailing Address - Fax:310-953-3281
Practice Address - Street 1:12655 W JEFFERSON BLVD FL 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7008
Practice Address - Country:US
Practice Address - Phone:310-907-9215
Practice Address - Fax:310-953-3281
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA36828225100000X, 2251S0007X, 2251X0800X, 261QP2000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy