Provider Demographics
NPI:1235153545
Name:ZEIGLER, MARK HENRY (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HENRY
Last Name:ZEIGLER
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 1:35 MARY FISHER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-5904
Mailing Address - Country:US
Mailing Address - Phone:970-731-3303
Mailing Address - Fax:970-731-2201
Practice Address - Street 1:35 MARY FISHER CIRCLE
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-5904
Practice Address - Country:US
Practice Address - Phone:970-731-3303
Practice Address - Fax:970-731-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60878339Medicaid
COC800007Medicare PIN
CO60878339Medicaid