Healthcare Provider Details

I. General information

NPI: 1154661908
Provider Name (Legal Business Name): BEVERLY ANN ZYWICZYNSI LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 OAK HARBOR RD
FREMONT OH
43420-1025
US

IV. Provider business mailing address

1406 OAK HARBOR RD
FREMONT OH
43420-1025
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-2589
  • Fax:
Mailing address:
  • Phone: 419-332-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: