MEDICARE: ZACHARY POREDA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	016498	OH
2	225100000X	Physical Therapist	016498	OH
3	2251X0800X	Orthopedic Physical Therapist	016498	OH

General Provider Information

NPI Number	:	1114415916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY POREDA PT, DPT

Provider Business Mailing Address
First Line	:	2546 CENTER RD
Second Line	:
City	:	HINCKLEY
State	:	OH
Zip	:	44233-9561
Country	:	US
Telephone Number	:	330-558-0100
Fax Number	:	330-558-0110

Provider Business Practice Location Address
First Line	:	34 W WASHINGTON ST
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3026
Country	:	US
Telephone Number	:	440-247-2644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/22/2022

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