Provider Demographics
NPI:1831344068
Name:ZAMZOW, COURTNEY (MPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ZAMZOW
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SKYPARK DR STE 235
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4753
Mailing Address - Country:US
Mailing Address - Phone:310-791-7980
Mailing Address - Fax:310-791-7995
Practice Address - Street 1:3701 SKYPARK DR STE 235
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-791-7980
Practice Address - Fax:310-791-7995
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35117OtherPT LICENSE
CAW14553OtherMEDICARE GROUP NUMBER
CAW14553OtherMEDICARE GROUP NUMBER