Provider Demographics
NPI:1649341967
Name:ZAK, PATRICK J (RPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:ZAK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RIO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-4302
Mailing Address - Country:US
Mailing Address - Phone:208-634-8517
Mailing Address - Fax:208-634-5763
Practice Address - Street 1:319 DEINHARD LN
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4703
Practice Address - Country:US
Practice Address - Phone:208-634-8517
Practice Address - Fax:208-292-2817
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805164900Medicaid
IDRPT 557Medicare UPIN