Provider Demographics
NPI:1700226834
Name:ZELENKA, JUSTIN PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:PAUL
Last Name:ZELENKA
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 1:343 GAZEBO LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7121
Mailing Address - Country:US
Mailing Address - Phone:630-532-0780
Mailing Address - Fax:
Practice Address - Street 1:343 GAZEBO LN
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7121
Practice Address - Country:US
Practice Address - Phone:630-532-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5514225100000X
WI12269-24225100000X
IL070018328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist