Active NPI
Zachary David Pevnick, DPT
- Geriatric Physical Therapist
- Los Angeles, CA
National Provider Identifier
1578879516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 36828
- Practice address
- 12655 W Jefferson Blvd FL 4
Los Angeles, CA 90066-7008 - Phone
- (310) 907-9215
- Fax
- (310) 953-3281
- NPI assigned
- Aug 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 36828 | CA | |
| Sports Physical Therapist | 2251S0007X | 36828 | CA | |
| Orthopedic Physical Therapist | 2251X0800X | 36828 | CA | |
| Physical Therapy Clinic/Center | 261QP2000X | 36828 | CA | |
| Geriatric Physical Therapist | 2251G0304X | 36828 | CA | Primary |
Addresses
Primary practice location
12655 W Jefferson Blvd FL 4
Los Angeles, CA 90066-7008
Mailing address
12655 W Jefferson Blvd FL 4
Los Angeles, CA 90066-7008
Phone (310) 907-9215
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36828 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1578879516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12655 W JEFFERSON BLVD FL 4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900667008",
"telephone_number": "310-907-9215",
"fax_number": "310-953-3281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12655 W JEFFERSON BLVD FL 4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900667008",
"telephone_number": "310-907-9215",
"fax_number": "310-953-3281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEVNICK",
"first_name": "ZACHARY",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-27",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "36828",
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "CA",
"license": "36828",
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "CA",
"license": "36828",
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "CA",
"license": "36828",
"primary": false
},
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "CA",
"license": "36828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.