Healthcare Provider Details

I. General information

NPI: 1205046455
Provider Name (Legal Business Name): ANTHONY PAUL ZUCCARO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD
WARREN MI
48088-6683
US

IV. Provider business mailing address

50242 HILLSIDE DR
MACOMB MI
48044-1222
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7825
  • Fax: 586-582-7826
Mailing address:
  • Phone: 586-412-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003392
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: