Healthcare Provider Details

I. General information

NPI: 1629837604
Provider Name (Legal Business Name): JOSE ZAPATA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W COTTONWOOD LN
CASA GRANDE AZ
85122-2552
US

IV. Provider business mailing address

177 W COTTONWOOD LN
CASA GRANDE AZ
85122-2552
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3800
  • Fax:
Mailing address:
  • Phone: 520-836-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: