Provider Demographics
NPI:1710991625
Name:ZINGG, MICHAEL THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ZINGG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MPT LLC
Other - Middle Name:
Other - Last Name:PHYSICAL THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4939
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0092
Mailing Address - Country:US
Mailing Address - Phone:541-286-5516
Mailing Address - Fax:541-843-1234
Practice Address - Street 1:98158 W BENHAM LN STE 10
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9546
Practice Address - Country:US
Practice Address - Phone:541-286-5516
Practice Address - Fax:541-843-1234
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3893225100000X
CA19213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR063383Medicaid
CAPT0192130Medicaid
OR063383Medicaid
CA0PT192130Medicare ID - Type Unspecified
CAPT0192130Medicaid