Healthcare Provider Details

I. General information

NPI: 1649774928
Provider Name (Legal Business Name): RAYMOND DUSTIN ZOLMAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 MYSTIC VALLEY PKWY STE 12
MEDFORD MA
02155-6931
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 781-960-6030
  • Fax: 781-350-3060
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: