Provider Demographics
NPI:1932407368
Name:ZELENAK, PAUL PAVEL (RPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:PAVEL
Last Name:ZELENAK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CORONADO CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3232
Mailing Address - Country:US
Mailing Address - Phone:707-539-8908
Mailing Address - Fax:
Practice Address - Street 1:11 CORONADO CIR
Practice Address - Street 2:N
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3232
Practice Address - Country:US
Practice Address - Phone:707-539-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 8946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist