Provider Demographics
NPI:1861728586
Name:ZMINA, LIANNA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LIANNA
Middle Name:MARIE
Last Name:ZMINA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE #1000
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4475
Mailing Address - Country:US
Mailing Address - Phone:310-640-9911
Mailing Address - Fax:310-322-8068
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE #1000
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4475
Practice Address - Country:US
Practice Address - Phone:310-640-9911
Practice Address - Fax:310-322-8068
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant