Provider Demographics
NPI:1104317213
Name:KULZER, ZACHARY BRUCE (DPT, PT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:BRUCE
Last Name:KULZER
Suffix:
Gender:
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-1550
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:206 OLD CORINTH RD
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2932
Practice Address - Country:US
Practice Address - Phone:601-583-9464
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04704015Medicaid