Provider Demographics
NPI:1568486991
Name:ZAYAC, JACQUELINE M (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:ZAYAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4011
Mailing Address - Country:US
Mailing Address - Phone:650-685-4800
Mailing Address - Fax:
Practice Address - Street 1:800 S CLAREMONT ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1449
Practice Address - Country:US
Practice Address - Phone:650-685-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT298771Medicare PIN