MEDICARE: DR. ZACHARY ALEXANDER CUPPLES 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	225100000X	Physical Therapist	004933	IA
2	225100000X	Physical Therapist	070018983	IL
3	225100000X	Physical Therapist	10973	AZ
4	2251X0800X	Orthopedic Physical Therapist	4212	NV

General Provider Information

NPI Number	:	1962771857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY ALEXANDER CUPPLES PT, DPT

Provider Business Mailing Address
First Line	:	4858 E BASELINE RD
Second Line	:	SUITE 107
City	:	MESA
State	:	AZ
Zip	:	85206-4638
Country	:	US
Telephone Number	:	480-807-6500
Fax Number	:	480-897-2700

Provider Business Practice Location Address
First Line	:	8020 S RAINBOW BLVD STE 151
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6483
Country	:	US
Telephone Number	:	702-706-3846
Fax Number	:

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

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	04/22/2025

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