Provider Demographics
NPI:1902918766
Name:ZAKRZEWSKI, JOHN WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:ZAKRZEWSKI
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:PO BOX 711185
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:2045 BROADWATER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4810
Practice Address - Country:US
Practice Address - Phone:406-656-0950
Practice Address - Fax:406-656-0970
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1389 PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000050844Medicare ID - Type Unspecified