Healthcare Provider Details

I. General information

NPI: 1972411130
Provider Name (Legal Business Name): ZACHARY MAYER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10224 S KEDZIE AVE STE C
EVERGREEN PARK IL
60805-3700
US

IV. Provider business mailing address

10224 S KEDZIE AVE STE C
EVERGREEN PARK IL
60805-3700
US

V. Phone/Fax

Practice location:
  • Phone: 773-941-6132
  • Fax:
Mailing address:
  • Phone: 773-941-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040819
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: