Provider Demographics
NPI:1619457652
Name:ZOUBEK, JERRY JOSEPH
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:JOSEPH
Last Name:ZOUBEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BOSTON POST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2434
Mailing Address - Country:US
Mailing Address - Phone:860-444-8713
Mailing Address - Fax:860-444-1671
Practice Address - Street 1:86 BOSTON POST RD STE 1
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2434
Practice Address - Country:US
Practice Address - Phone:860-444-8713
Practice Address - Fax:860-444-1671
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist