Provider Demographics
NPI:1053374058
Name:ZELLER, BRIAN L (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:ZELLER
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3522
Mailing Address - Country:US
Mailing Address - Phone:507-457-5575
Mailing Address - Fax:507-457-5606
Practice Address - Street 1:175 W MARK ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3384
Practice Address - Country:US
Practice Address - Phone:507-457-5575
Practice Address - Fax:507-457-5606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer