MEDICARE: MRS. KALLEEN MARIE ZAMZOW PT

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	1118230	TX

General Provider Information

NPI Number	:	1710608419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALLEEN MARIE ZAMZOW PT

Provider Business Mailing Address
First Line	:	1406 E HOUSTON ST UNIT D
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5346
Country	:	US
Telephone Number	:	361-542-4652
Fax Number	:	361-542-4653

Provider Business Practice Location Address
First Line	:	1406 E HOUSTON ST UNIT D
Second Line	:
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5346
Country	:	US
Telephone Number	:	361-542-4652
Fax Number	:	361-542-4653

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

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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