Provider Demographics
NPI:1972000701
Name:ZIDEK, WADE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:
Last Name:ZIDEK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 COUNTY ROAD 290
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-6468
Mailing Address - Country:US
Mailing Address - Phone:361-772-6638
Mailing Address - Fax:
Practice Address - Street 1:1200 CARL RAMERT DR
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-4868
Practice Address - Country:US
Practice Address - Phone:361-293-2321
Practice Address - Fax:361-293-5747
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1296300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist