Healthcare Provider Details

I. General information

NPI: 1740106228
Provider Name (Legal Business Name): ZACHARY FARSON PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 FOREST HILLS RD
LOVES PARK IL
61111-4367
US

IV. Provider business mailing address

8491 N HAVEN CT
ROCKFORD IL
61108-7014
US

V. Phone/Fax

Practice location:
  • Phone: 815-509-8625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: