Healthcare Provider Details

I. General information

NPI: 1851093108
Provider Name (Legal Business Name): ANNA ZNAMENSKAYA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 FERRIS SQ STE 120
SAN DIEGO CA
92121-3251
US

IV. Provider business mailing address

6215 FERRIS SQ STE 120
SAN DIEGO CA
92121-3251
US

V. Phone/Fax

Practice location:
  • Phone: 800-683-1209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52118
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number141627
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: