Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT002983 | WV |
NPI | 1003292640 |
---|---|
Provider Name | Peter Zatezalo |
First Address | Wheeling, WV 26003-6639 |
Second Address | Irving, TX 75063-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |