Provider Demographics
NPI:1073347571
Name:MUNIZZA, ZACHARY SEAN
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:SEAN
Last Name:MUNIZZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 41ST ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1731
Mailing Address - Country:US
Mailing Address - Phone:971-476-8681
Mailing Address - Fax:
Practice Address - Street 1:2700 NE 4TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3628
Practice Address - Country:US
Practice Address - Phone:541-323-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist