Provider Demographics
NPI:1740374198
Name:ZIOLKOWSKI, SCOTT DAVID (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:ZIOLKOWSKI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:
Practice Address - Street 1:711 W 9TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1252
Practice Address - Country:US
Practice Address - Phone:715-532-3439
Practice Address - Fax:715-532-0120
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40348900Medicaid
WI000686021Medicare PIN