Provider Demographics
NPI:1851035869
Name:BABCHANIK, SVYATOSLAV (PT)
Entity type:Individual
Prefix:
First Name:SVYATOSLAV
Middle Name:
Last Name:BABCHANIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:BABCHANIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7666 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5735
Mailing Address - Country:US
Mailing Address - Phone:916-698-8555
Mailing Address - Fax:
Practice Address - Street 1:7666 SAN SIMEON DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5735
Practice Address - Country:US
Practice Address - Phone:916-698-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299062261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy