MEDICARE: SAMANTHA WENSON ZINNECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	5501018287	MI

General Provider Information

NPI Number	:	1013435643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WENSON ZINNECKER

Provider Business Mailing Address
First Line	:	25547 RIDGEWOOD DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-1058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 MADISON ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-2126
Country	:	US
Telephone Number	:	248-797-9359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2017
Last Update Date	:	04/18/2023

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