MEDICARE: MISS KATRINA LYNN ZAPPALA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT37967	CA

General Provider Information

NPI Number	:	1417244922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATRINA LYNN ZAPPALA DPT

Provider Business Mailing Address
First Line	:	28924 S WESTERN AVE
Second Line	:	SUITE 101
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0885
Country	:	US
Telephone Number	:	310-548-0104
Fax Number	:	310-548-0559

Provider Business Practice Location Address
First Line	:	28924 S WESTERN AVE
Second Line	:	SUITE 101
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0885
Country	:	US
Telephone Number	:	310-548-0104
Fax Number	:	310-548-0559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	05/20/2020

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