Healthcare Provider Details

I. General information

NPI: 1184191389
Provider Name (Legal Business Name): LINDA M ZUKOWSKI NC LMBT #5951
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8384 SIX FORKS RD STE 203
RALEIGH NC
27615-5089
US

IV. Provider business mailing address

8384 SIX FORKS RD STE 203
RALEIGH NC
27615-5089
US

V. Phone/Fax

Practice location:
  • Phone: 919-602-5742
  • Fax:
Mailing address:
  • Phone: 919-602-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: