Provider Demographics
NPI:1578008306
Name:ZINNAH, TONY III (PT,DPT)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:ZINNAH
Suffix:III
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RIVER LODGE TRL S APT 1028
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0858
Mailing Address - Country:US
Mailing Address - Phone:903-720-8890
Mailing Address - Fax:
Practice Address - Street 1:3200 RIVER LODGE TRL S APT 1028
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0858
Practice Address - Country:US
Practice Address - Phone:903-720-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist