Healthcare Provider Details

I. General information

NPI: 1346613627
Provider Name (Legal Business Name): IAN ZAPORSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STEPHENSON HWY STE 300
TROY MI
48083-1118
US

IV. Provider business mailing address

500 STEPHENSON HWY STE 300
TROY MI
48083-1118
US

V. Phone/Fax

Practice location:
  • Phone: 586-510-7997
  • Fax: 586-439-6240
Mailing address:
  • Phone: 586-510-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: