Healthcare Provider Details

I. General information

NPI: 1023421633
Provider Name (Legal Business Name): JORDAN ZUCCARELLI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E IRON AVE
SALINA KS
67401-2634
US

IV. Provider business mailing address

405 E IRON AVE
SALINA KS
67401-2634
US

V. Phone/Fax

Practice location:
  • Phone: 785-764-0497
  • Fax: 785-746-0428
Mailing address:
  • Phone: 785-764-0497
  • Fax: 785-746-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04804
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: