Provider Demographics
NPI:1912278144
Name:ZAVADA, HALYNA (PT)
Entity Type:Individual
Prefix:
First Name:HALYNA
Middle Name:
Last Name:ZAVADA
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 1:4312 WOODMAN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5546
Mailing Address - Country:US
Mailing Address - Phone:818-205-9366
Mailing Address - Fax:
Practice Address - Street 1:4312 WOODMAN AVE
Practice Address - Street 2:STE 102
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5546
Practice Address - Country:US
Practice Address - Phone:818-205-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35630208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35630OtherLICENSE