Healthcare Provider Details

I. General information

NPI: 1972174290
Provider Name (Legal Business Name): ZACHARY MARTIN LYGIZOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LARCHMONT BLVD STE 825
LOS ANGELES CA
90004-6400
US

IV. Provider business mailing address

2019 1/2 N VERMONT AVE
LOS ANGELES CA
90027-1967
US

V. Phone/Fax

Practice location:
  • Phone: 323-464-4458
  • Fax:
Mailing address:
  • Phone: 847-609-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: