Healthcare Provider Details

I. General information

NPI: 1265647275
Provider Name (Legal Business Name): MARK DAVID ZUCKER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 TULIP CT
LIBERTY TOWNSHIP OH
45044-9726
US

IV. Provider business mailing address

6530 TULIP CT
LIBERTY TOWNSHIP OH
45044-9726
US

V. Phone/Fax

Practice location:
  • Phone: 513-348-9698
  • Fax:
Mailing address:
  • Phone: 513-348-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: