Provider Demographics
NPI:1154857068
Name:JUSTIN ZELENKA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:JUSTIN ZELENKA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ZELENKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-686-2284
Mailing Address - Street 1:343 GAZEBO LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7121
Mailing Address - Country:US
Mailing Address - Phone:630-532-0780
Mailing Address - Fax:
Practice Address - Street 1:343 GAZEBO LN
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7121
Practice Address - Country:US
Practice Address - Phone:630-532-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty