Healthcare Provider Details

I. General information

NPI: 1487843017
Provider Name (Legal Business Name): NEAL ZUMBERGE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S CEDAR ST
MANISTIQUE MI
49854-1426
US

IV. Provider business mailing address

2510 KNOLLWOOD DR
NEW BRIGHTON MN
55112-4415
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-8363
  • Fax:
Mailing address:
  • Phone: 906-202-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: