Provider Demographics
NPI:1346082005
Name:ZUELKE, BRIGHTYN (DPT)
Entity type:Individual
Prefix:
First Name:BRIGHTYN
Middle Name:
Last Name:ZUELKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SANDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-1356
Mailing Address - Country:US
Mailing Address - Phone:920-609-9059
Mailing Address - Fax:
Practice Address - Street 1:1774 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54173-8100
Practice Address - Country:US
Practice Address - Phone:920-770-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16781-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist