Provider Demographics
NPI:1023569894
Name:KUMAR, ZALAK ASHIQ
Entity Type:Individual
Prefix:MRS
First Name:ZALAK
Middle Name:ASHIQ
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 RILEY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2168
Mailing Address - Country:US
Mailing Address - Phone:405-612-7370
Mailing Address - Fax:
Practice Address - Street 1:307 RILEY DR APT 3
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-2168
Practice Address - Country:US
Practice Address - Phone:405-612-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant