Provider Demographics
NPI:1821245986
Name:GHOSHAL, ZOE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:MARIE
Last Name:GHOSHAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:MARIE
Other - Last Name:GIWOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1717 W. NORTHERN AVE.
Mailing Address - Street 2:#117
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-535-8254
Mailing Address - Fax:
Practice Address - Street 1:3775 MODOC RD.
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-879-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18269225100000X
CA35348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist