Provider Demographics
NPI:1255686374
Name:ZOOM PHYSICAL THERAPY AND WELLNESS, P.L.L.C.
Entity Type:Organization
Organization Name:ZOOM PHYSICAL THERAPY AND WELLNESS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:STEFKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-648-1592
Mailing Address - Street 1:PO BOX 3502
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3502
Mailing Address - Country:US
Mailing Address - Phone:361-237-1670
Mailing Address - Fax:361-237-1703
Practice Address - Street 1:2806 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3216
Practice Address - Country:US
Practice Address - Phone:361-237-1670
Practice Address - Fax:361-237-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-14
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135507225100000X
TX109364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty