Healthcare Provider Details

I. General information

NPI: 1013988138
Provider Name (Legal Business Name): JUSTINE ZIKUDA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. JUSTINE REED

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 PHEASANT LN
WATERLOO IA
50701-5200
US

IV. Provider business mailing address

3820 PHEASANT LN
WATERLOO IA
50701-5200
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-6995
  • Fax:
Mailing address:
  • Phone: 319-233-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03594
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: