Healthcare Provider Details

I. General information

NPI: 1285765297
Provider Name (Legal Business Name): THOMAS ZMIERSKI P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 W US HIGHWAY 30
SCHERERVILLE IN
46375-1562
US

IV. Provider business mailing address

9950 CALUMET AVE
MUNSTER IN
46321-4028
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5381
  • Fax:
Mailing address:
  • Phone: 219-762-7136
  • Fax: 219-934-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002359A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: