Provider Demographics
NPI:1447869193
Name:DREVLOW, ZACHARY (PT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DREVLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3121
Mailing Address - Country:US
Mailing Address - Phone:701-667-0745
Mailing Address - Fax:701-667-0707
Practice Address - Street 1:1000 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0913
Practice Address - Country:US
Practice Address - Phone:701-355-1295
Practice Address - Fax:701-323-7046
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty