Provider Demographics
NPI:1922445964
Name:ZELKOWSKI, CHARLES WALTER (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WALTER
Last Name:ZELKOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 N 1ST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-2520
Mailing Address - Country:US
Mailing Address - Phone:989-539-4167
Mailing Address - Fax:989-539-4436
Practice Address - Street 1:158 N 1ST ST
Practice Address - Street 2:SUITE D
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-2520
Practice Address - Country:US
Practice Address - Phone:989-539-4167
Practice Address - Fax:989-539-4436
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist