Healthcare Provider Details

I. General information

NPI: 1477442804
Provider Name (Legal Business Name): ZACHARY GRIFFITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W ROOSEVELT RD
CHICAGO IL
60608-1316
US

IV. Provider business mailing address

616 W SURF ST APT 3
CHICAGO IL
60657-9489
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-8043
  • Fax:
Mailing address:
  • Phone: 217-722-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029136
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070.029136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: