Provider Demographics
NPI:1639817042
Name:ZIZACK, TERESA G (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:G
Last Name:ZIZACK
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 1:1203 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6906
Mailing Address - Country:US
Mailing Address - Phone:813-796-7921
Mailing Address - Fax:
Practice Address - Street 1:1203 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:TOPSAIL BEACH
Practice Address - State:NC
Practice Address - Zip Code:28445-6906
Practice Address - Country:US
Practice Address - Phone:813-796-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist