Healthcare Provider Details

I. General information

NPI: 1669055398
Provider Name (Legal Business Name): NIMA ZAAL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MAIN ST
BELLEVILLE MI
48111-2650
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-6440
  • Fax: 734-418-7553
Mailing address:
  • Phone: 888-830-4125
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40QA01999300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302049
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01999300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: