Healthcare Provider Details

I. General information

NPI: 1972705804
Provider Name (Legal Business Name): ALAN ZIDEK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 CHEVIOT RD
CINCINNATI OH
45247-7020
US

IV. Provider business mailing address

3827 PAXTON AVE
CINCINNATI OH
45209-2414
US

V. Phone/Fax

Practice location:
  • Phone: 513-923-1700
  • Fax:
Mailing address:
  • Phone: 501-213-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 013396
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2829
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: