Provider Demographics
NPI:1073553350
Name:ZUCK, MARK TAPANI (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TAPANI
Last Name:ZUCK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 TABLE MESA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5600
Mailing Address - Country:US
Mailing Address - Phone:303-447-8105
Mailing Address - Fax:303-447-2741
Practice Address - Street 1:4790 TABLE MESA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5600
Practice Address - Country:US
Practice Address - Phone:303-447-8105
Practice Address - Fax:303-447-2741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO8325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804057Medicare ID - Type Unspecified