Healthcare Provider Details

I. General information

NPI: 1912301219
Provider Name (Legal Business Name): ZACHARY SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SPRINGFIELD DR STE 300
BLOOMINGDALE IL
60108-2215
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-1173
US

V. Phone/Fax

Practice location:
  • Phone: 630-946-2354
  • Fax:
Mailing address:
  • Phone: 630-545-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020900
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.020900
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: