Provider Demographics
NPI:1598765224
Name:ZUKOWSKI, ANTHONY J (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:ZUKOWSKI
Suffix:
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 1:923 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1821
Mailing Address - Country:US
Mailing Address - Phone:860-658-0308
Mailing Address - Fax:860-651-1994
Practice Address - Street 1:923 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1821
Practice Address - Country:US
Practice Address - Phone:860-658-0308
Practice Address - Fax:860-651-1994
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4478157OtherAENTA US HEALTHCARE
080003265CT03OtherANTHEM BLUE CROSS
4478157OtherAENTA US HEALTHCARE
C02637Medicare UPIN