Provider Demographics
NPI:1548978109
Name:ZUCAL-NYE, LAURETTA
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:
Last Name:ZUCAL-NYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 WYNONAH DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9410
Mailing Address - Country:US
Mailing Address - Phone:570-391-2907
Mailing Address - Fax:
Practice Address - Street 1:3225 N 5TH STREET HWY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2451
Practice Address - Country:US
Practice Address - Phone:610-939-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004353225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant