Provider Demographics
NPI:1548281256
Name:ZIDEK, MARGARET MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:ZIDEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10682 LOS ALAMITOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2118
Mailing Address - Country:US
Mailing Address - Phone:562-795-5295
Mailing Address - Fax:562-795-5297
Practice Address - Street 1:10682 LOS ALAMITOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2118
Practice Address - Country:US
Practice Address - Phone:562-795-5295
Practice Address - Fax:562-795-5297
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT15066AMedicare ID - Type Unspecified