Provider Demographics
NPI:1710608419
Name:ZAMZOW, KALLEEN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KALLEEN
Middle Name:MARIE
Last Name:ZAMZOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1406 E HOUSTON ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5346
Mailing Address - Country:US
Mailing Address - Phone:361-542-4652
Mailing Address - Fax:361-542-4653
Practice Address - Street 1:1406 E HOUSTON ST UNIT D
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5346
Practice Address - Country:US
Practice Address - Phone:361-542-4652
Practice Address - Fax:361-542-4653
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11182302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic