Provider Demographics
NPI:1679279277
Name:ZELCER, MAYA JUDITH (PTA)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:JUDITH
Last Name:ZELCER
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 1:4120 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3433
Mailing Address - Country:US
Mailing Address - Phone:310-733-6918
Mailing Address - Fax:
Practice Address - Street 1:719 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2601
Practice Address - Country:US
Practice Address - Phone:310-260-9039
Practice Address - Fax:310-260-1091
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant