Healthcare Provider Details

I. General information

NPI: 1013272475
Provider Name (Legal Business Name): BRET E ZOWADA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 3RD ST
SHERIDAN WY
82801-3606
US

IV. Provider business mailing address

50 W 3RD ST
SHERIDAN WY
82801-3606
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-2092
  • Fax: 307-673-1969
Mailing address:
  • Phone: 307-672-2092
  • Fax: 307-673-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1240
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: