Provider Demographics
NPI:1003106733
Name:ZACKOWSKI, CORINA (LMT)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:ZACKOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 RIMROCK RD STE I
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0700
Mailing Address - Country:US
Mailing Address - Phone:406-245-5100
Mailing Address - Fax:
Practice Address - Street 1:1690 RIMROCK RD STE I
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-245-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist