Basic Information
| Provider Information | |||||||||
| NPI: | 1972000701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIDEK | ||||||||
| FirstName: | WADE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 868 COUNTY ROAD 290 | ||||||||
| Address2: | |||||||||
| City: | SHINER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779846468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617726638 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 CARL RAMERT DR | ||||||||
| Address2: | |||||||||
| City: | YOAKUM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779954868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612932321 | ||||||||
| FaxNumber: | 3612935747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1296300 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.