Provider Demographics
NPI:1831242650
Name:ZWETSLOOT, PAUL HENRY (MPT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HENRY
Last Name:ZWETSLOOT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 HIGH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9045
Mailing Address - Country:US
Mailing Address - Phone:530-938-1686
Mailing Address - Fax:
Practice Address - Street 1:590 MAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-2339
Practice Address - Country:US
Practice Address - Phone:530-938-3344
Practice Address - Fax:530-938-3340
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20201225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00185370OtherRAILROAD MEDICARE PIN
CA0PT202011Medicare ID - Type UnspecifiedPROVIDER IDENTIFIER #