Healthcare Provider Details

I. General information

NPI: 1285742304
Provider Name (Legal Business Name): PETER JAMES ZEPELAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLAISDELL AVE
MINNEAPOLIS MN
55404-2414
US

IV. Provider business mailing address

2001 BLAISDELL AVE
MINNEAPOLIS MN
55404-2414
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5900
  • Fax: 952-993-8220
Mailing address:
  • Phone: 952-993-5900
  • Fax: 952-993-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8065
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070010135
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: