Provider Demographics
NPI:1346613627
Name:ZAPORSKI, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:ZAPORSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27472 SCHOENHERR RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6688
Mailing Address - Country:US
Mailing Address - Phone:586-439-6243
Mailing Address - Fax:586-439-6240
Practice Address - Street 1:27472 SCHOENHERR RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6688
Practice Address - Country:US
Practice Address - Phone:586-439-6243
Practice Address - Fax:586-439-6240
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant