Basic Information
| Provider Information | |||||||||
| NPI: | 1194016329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHABAT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12301 WOODLEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913441815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188320411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11165 SEPULVEDA BLVD | ||||||||
| Address2: | SPA BLDG., PT DEP'T | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188375732 | ||||||||
| FaxNumber: | 8188372709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2011 | ||||||||
| LastUpdateDate: | 04/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | AT5557 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.