Healthcare Provider Details

I. General information

NPI: 1861538738
Provider Name (Legal Business Name): RICHARD EDWARD ZITNIK JR. MS, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17773 HIGHWAY 104
ROBERTSDALE AL
36567
US

IV. Provider business mailing address

17773 HIGHWAY 104
ROBERTSDALE AL
36567
US

V. Phone/Fax

Practice location:
  • Phone: 251-947-7930
  • Fax: 251-947-7931
Mailing address:
  • Phone: 251-947-7930
  • Fax: 251-947-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH2036
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: