Healthcare Provider Details

I. General information

NPI: 1649365941
Provider Name (Legal Business Name): KRYSTI MICHELE ZIZZO M.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31151 PLYMOUTH RD
LIVONIA MI
48150
US

IV. Provider business mailing address

6914 FENTON
DEARBORN HEIGHTS MI
48127
US

V. Phone/Fax

Practice location:
  • Phone: 734-422-8600
  • Fax:
Mailing address:
  • Phone: 313-682-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: