Provider Demographics
NPI:1376903013
Name:ZAJAC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ZAJAC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZAJAC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-616-8644
Mailing Address - Street 1:10 BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3242
Mailing Address - Country:US
Mailing Address - Phone:603-616-8644
Mailing Address - Fax:603-788-4358
Practice Address - Street 1:10 BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3242
Practice Address - Country:US
Practice Address - Phone:603-616-8644
Practice Address - Fax:603-788-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2153261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528037934Medicare PIN