Healthcare Provider Details

I. General information

NPI: 1265365316
Provider Name (Legal Business Name): ZACHARY TYLER BLANCHARD DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 GOOD HOMES RD
ORLANDO FL
32818-6628
US

IV. Provider business mailing address

100 E 2ND AVE STE 210
ROME GA
30161-1718
US

V. Phone/Fax

Practice location:
  • Phone: 407-293-3156
  • Fax: 407-293-3155
Mailing address:
  • Phone: 407-293-3156
  • Fax: 407-293-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: