Healthcare Provider Details

I. General information

NPI: 1356010870
Provider Name (Legal Business Name): CHRISTOPHER MARTIN WELLER ZINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

3776 HAZEL TRL UNIT B
WOODBURY MN
55129-8703
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3456
  • Fax:
Mailing address:
  • Phone: 651-356-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12444
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: