Provider Demographics
NPI:1487843017
Name:ZUMBERGE, NEAL (PTA)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:ZUMBERGE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4415
Mailing Address - Country:US
Mailing Address - Phone:906-202-0391
Mailing Address - Fax:
Practice Address - Street 1:226 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1426
Practice Address - Country:US
Practice Address - Phone:906-341-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant