Provider Demographics
NPI:1750345567
Name:ZYGAR, JOSEPH R (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:ZYGAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 64TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-426-5920
Practice Address - Street 1:2300 KATI CT
Practice Address - Street 2:STE B
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-5903
Practice Address - Fax:360-426-5920
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7291404Medicaid
WA7291404Medicaid
AB11155Medicare ID - Type Unspecified