Provider Demographics
NPI:1720350846
Name:ZANDSTRA, MARIKA ELAINE (PT)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:ELAINE
Last Name:ZANDSTRA
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 1:5670 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1041
Mailing Address - Country:US
Mailing Address - Phone:219-384-8692
Mailing Address - Fax:
Practice Address - Street 1:1101 GLENDALE BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-476-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012289225100000X
IN05007074A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist