Provider Demographics
NPI:1831708429
Name:ZUKIE, MARY J (RN,BSN LMT,BCTMB)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:ZUKIE
Suffix:
Gender:F
Credentials:RN,BSN LMT,BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 WARREN RD DN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4113
Mailing Address - Country:US
Mailing Address - Phone:440-941-7255
Mailing Address - Fax:
Practice Address - Street 1:4168 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-6100
Practice Address - Country:US
Practice Address - Phone:216-671-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023370225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist