Healthcare Provider Details

I. General information

NPI: 1548281256
Provider Name (Legal Business Name): MARGARET MARY ZIDEK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10682 LOS ALAMITOS BLVD
LOS ALAMITOS CA
90720-2118
US

IV. Provider business mailing address

10682 LOS ALAMITOS BLVD
LOS ALAMITOS CA
90720-2118
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-5295
  • Fax: 562-795-5297
Mailing address:
  • Phone: 562-795-5295
  • Fax: 562-795-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: