Healthcare Provider Details

I. General information

NPI: 1760830079
Provider Name (Legal Business Name): ZACHERY EUSTANCE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

14924 SENECA RD APT 3
VICTORVILLE CA
92392-2248
US

V. Phone/Fax

Practice location:
  • Phone: 585-315-3500
  • Fax:
Mailing address:
  • Phone: 585-315-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: