Provider Demographics
NPI:1518373729
Name:ZEY, MILDRED (LMT)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:ZEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S STATE ROUTE 157
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1042
Mailing Address - Country:US
Mailing Address - Phone:618-288-3610
Mailing Address - Fax:
Practice Address - Street 1:3407 S STATE ROUTE 157
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1042
Practice Address - Country:US
Practice Address - Phone:618-288-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist