Provider Demographics
NPI:1790079754
Name:ZALTA, JENNIFER (NCTMB)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZALTA
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:420 S. JACKSON ST
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0214
Mailing Address - Country:US
Mailing Address - Phone:307-690-8228
Mailing Address - Fax:
Practice Address - Street 1:420 S. JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-690-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist