Healthcare Provider Details

I. General information

NPI: 1740278191
Provider Name (Legal Business Name): PAUL MICHAEL ZIEMBA ATC, OTC, OPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/15/2023
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GAYLORD PKWY STE 710
FRISCO TX
75034-9635
US

IV. Provider business mailing address

9301 N CENTRAL EXPY STE 500
DALLAS TX
75231-0805
US

V. Phone/Fax

Practice location:
  • Phone: 214-220-2468
  • Fax: 214-720-1982
Mailing address:
  • Phone: 214-220-2468
  • Fax: 214-220-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number10-0627
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1248
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1248
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1248
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT8888
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: