Provider Demographics
NPI:1073588083
Name:ZINN, STANFORD WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:STANFORD
Middle Name:WAYNE
Last Name:ZINN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214
Mailing Address - Country:US
Mailing Address - Phone:410-444-2770
Mailing Address - Fax:410-426-0876
Practice Address - Street 1:5535 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214
Practice Address - Country:US
Practice Address - Phone:410-444-2770
Practice Address - Fax:410-426-0876
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ991OtherBCBS OF MD
MDT3140001OtherFEDERAL BC BLUE CHOICE
MDT3140001OtherFEDERAL BC BLUE CHOICE