Provider Demographics
NPI:1972740918
Name:ZENKER PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:ZENKER PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEEJAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZENKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-667-8778
Mailing Address - Street 1:101 COLLINS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 COLLINS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3176
Practice Address - Country:US
Practice Address - Phone:701-667-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1498261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1316108327OtherBCBS OF ND
ND55345Medicaid
ND55283Medicaid