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General NPI Number Information
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NPI Number | 1720856487
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Entity Type | Individual
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Provider Name | BROOKE ZUKOWSKI PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2003 W BROADWAY STE 105
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City | COLUMBIA
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State | MO
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Zip | 65203-1136
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Country | US
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Telephone | 724-814-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 3503 BRIARMONT AVE APT 310
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City | COLUMBIA
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State | MO
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Zip | 65201-3698
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2023047492
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License Number State | MO
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