Healthcare Provider Details

I. General information

NPI: 1801291836
Provider Name (Legal Business Name): TATIANA ZAGAYNOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BEDLES CT
SOUTH LEBANON OH
45065-8719
US

IV. Provider business mailing address

119 BEDLES CT
SOUTH LEBANON OH
45065-8719
US

V. Phone/Fax

Practice location:
  • Phone: 513-479-4099
  • Fax:
Mailing address:
  • Phone: 513-479-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.014581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: