Provider Demographics
NPI:1528037934
Name:ZAJAC, MARK GEORGE SR (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:GEORGE
Last Name:ZAJAC
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2153225100000X
MA24066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6961Medicare ID - Type Unspecified