Healthcare Provider Details

I. General information

NPI: 1164766515
Provider Name (Legal Business Name): MATTHEW ZAVALA MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N HOUGH ST SUITE 130
BARRINGTON IL
60010-3087
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-0090
  • Fax: 847-381-0181
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-019605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: