Provider Demographics
NPI:1760592315
Name:ZUREK, MELISSA (MOLLY)
Entity Type:Individual
Prefix:
First Name:MELISSA (MOLLY)
Middle Name:
Last Name:ZUREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 TOTTENHAM CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-2838
Mailing Address - Country:US
Mailing Address - Phone:512-331-5916
Mailing Address - Fax:
Practice Address - Street 1:6818 AUSTIN CENTER BLVD STE 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3199
Practice Address - Country:US
Practice Address - Phone:512-418-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2008330OtherLICENSE #