Healthcare Provider Details

I. General information

NPI: 1962633826
Provider Name (Legal Business Name): ELI ZYGMUNTOWICZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 WOODLAND PARK AVE N STE 100
SEATTLE WA
98103-7943
US

IV. Provider business mailing address

3800 WOODLAND PARK AVE N STE 100
SEATTLE WA
98103-7943
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-2396
  • Fax: 206-547-9286
Mailing address:
  • Phone: 206-284-2396
  • Fax: 206-547-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60095182
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: