Provider Demographics
NPI:1386736577
Name:PEVSNER, DAVID N (PT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:PEVSNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 KESTER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4523
Mailing Address - Country:US
Mailing Address - Phone:818-785-2726
Mailing Address - Fax:
Practice Address - Street 1:6725 KESTER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4523
Practice Address - Country:US
Practice Address - Phone:818-789-3819
Practice Address - Fax:818-789-3546
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR37365Medicare UPIN
CAWPT8202Medicare ID - Type UnspecifiedDAVID N. PEVSNER