Healthcare Provider Details

I. General information

NPI: 1851068894
Provider Name (Legal Business Name): ROSS ZAPPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CATLIN ST
BUFFALO MN
55313-2012
US

IV. Provider business mailing address

405 25TH AVE SW
WILLMAR MN
56201-5235
US

V. Phone/Fax

Practice location:
  • Phone: 763-684-3888
  • Fax:
Mailing address:
  • Phone: 320-979-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11955
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: