Healthcare Provider Details

I. General information

NPI: 1972000701
Provider Name (Legal Business Name): WADE ZIDEK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CARL RAMERT DR
YOAKUM TX
77995-4868
US

IV. Provider business mailing address

868 COUNTY ROAD 290
SHINER TX
77984-6468
US

V. Phone/Fax

Practice location:
  • Phone: 361-293-2321
  • Fax: 361-293-5747
Mailing address:
  • Phone: 361-772-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1296300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: