Provider Demographics
NPI:1356150296
Name:ZOLLER, JAYSA LYNN (PT)
Entity type:Individual
Prefix:
First Name:JAYSA
Middle Name:LYNN
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 COMMERCIAL CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9690
Mailing Address - Country:US
Mailing Address - Phone:785-456-1570
Mailing Address - Fax:785-456-1751
Practice Address - Street 1:1701 COMMERCIAL CIR STE 3
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9690
Practice Address - Country:US
Practice Address - Phone:785-456-1570
Practice Address - Fax:785-456-1571
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-06246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist