Healthcare Provider Details

I. General information

NPI: 1417244922
Provider Name (Legal Business Name): KATRINA LYNN ZAPPALA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA LYNN HERSKEDAL

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28924 S WESTERN AVE SUITE 101
RANCHO PALOS VERDES CA
90275-0885
US

IV. Provider business mailing address

28924 S WESTERN AVE SUITE 101
RANCHO PALOS VERDES CA
90275-0885
US

V. Phone/Fax

Practice location:
  • Phone: 310-548-0104
  • Fax: 310-548-0559
Mailing address:
  • Phone: 310-548-0104
  • Fax: 310-548-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: