Healthcare Provider Details

I. General information

NPI: 1386803070
Provider Name (Legal Business Name): JEFFREY ZAGAROLI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PINEVIEW DR NE
GRAND RAPIDS MI
49525-6706
US

IV. Provider business mailing address

2600 PINEVIEW DR NE
GRAND RAPIDS MI
49525-6706
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-0303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: