Provider Demographics
NPI:1770521262
Name:ZULOAGA, ANTONIO JAVIER (PT)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:JAVIER
Last Name:ZULOAGA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 BRAVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-6614
Mailing Address - Country:US
Mailing Address - Phone:724-942-8320
Mailing Address - Fax:
Practice Address - Street 1:155 WATERDAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2567
Practice Address - Country:US
Practice Address - Phone:724-941-2429
Practice Address - Fax:724-941-4634
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001201E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist