Healthcare Provider Details

I. General information

NPI: 1891128641
Provider Name (Legal Business Name): SHANE ZANATH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 N 92ND ST
SCOTTSDALE AZ
85258-4563
US

IV. Provider business mailing address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-3382
  • Fax: 480-704-3373
Mailing address:
  • Phone: 602-406-3181
  • Fax: 602-264-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-010484
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: