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General NPI Number Information
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NPI Number | 1154857068
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Entity Type | Organization
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Legal Business Name | JUSTIN ZELENKA PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 343 GAZEBO LN
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City | LOMBARD
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State | IL
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Zip | 60148-7121
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Country | US
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Telephone | 630-532-0780
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Fax |
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Provider Business Mailing Address
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Address Line | 343 GAZEBO LN
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City | LOMBARD
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State | IL
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Zip | 60148-7121
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Country | US
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Telephone | 630-532-0780
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Fax |
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | JUSTIN PAUL ZELENKA
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Credential | DPT
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Telephone | 630-686-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070018328
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License Number State | IL
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