Provider Demographics
NPI:1255544813
Name:ZIELINSKI, CHRISTYL JEAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTYL
Middle Name:JEAN
Last Name:ZIELINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CARVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1330
Mailing Address - Country:US
Mailing Address - Phone:920-207-7375
Mailing Address - Fax:
Practice Address - Street 1:220 HAVEN DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-3005
Practice Address - Country:US
Practice Address - Phone:920-550-5254
Practice Address - Fax:920-467-0696
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI539-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40374600Medicaid