Provider Demographics
NPI:1962644849
Name:ZULLO, ANTHONY KENNETH (LMP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:KENNETH
Last Name:ZULLO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6743
Mailing Address - Country:US
Mailing Address - Phone:253-232-4182
Mailing Address - Fax:
Practice Address - Street 1:6808 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5212
Practice Address - Country:US
Practice Address - Phone:253-232-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60016638172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist