Provider Demographics
NPI:1336309376
Name:STUKE, ZACHARIAH O (DPT)
Entity Type:Individual
Prefix:MR
First Name:ZACHARIAH
Middle Name:O
Last Name:STUKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PALACE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6264
Mailing Address - Country:US
Mailing Address - Phone:620-271-0700
Mailing Address - Fax:620-271-0703
Practice Address - Street 1:1800 PALACE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6264
Practice Address - Country:US
Practice Address - Phone:620-271-0700
Practice Address - Fax:620-271-0703
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS117012001Medicare PIN