MEDICARE: KRISTINA A ZOLLER DPT

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	225100000X	Physical Therapist	10301	CO
2	225100000X	Physical Therapist	070 014530	IL

General Provider Information

NPI Number	:	1396719340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA A ZOLLER DPT

Provider Business Mailing Address
First Line	:	PO BOX 4828
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-4828
Country	:	US
Telephone Number	:	970-569-3883
Fax Number	:	970-569-3884

Provider Business Practice Location Address
First Line	:	1140 EDWARDS VILL BLVD
Second Line	:	B208
City	:	EDWARDS
State	:	CO
Zip	:	81632-4828
Country	:	US
Telephone Number	:	970-569-3883
Fax Number	:	970-569-3884

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/06/2014

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