Provider Demographics
NPI:1194920801
Name:SABLJIC-MYERS, ZIVANA (PT)
Entity type:Individual
Prefix:
First Name:ZIVANA
Middle Name:
Last Name:SABLJIC-MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ZIVANA
Other - Middle Name:
Other - Last Name:SABLJIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 PARK PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9806
Mailing Address - Country:US
Mailing Address - Phone:717-477-8030
Mailing Address - Fax:717-477-8040
Practice Address - Street 1:20 PARK PL
Practice Address - Street 2:SUITE 2
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9806
Practice Address - Country:US
Practice Address - Phone:717-477-8030
Practice Address - Fax:717-477-8040
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025514930001Medicaid
PA1025514930001Medicaid