Healthcare Provider Details

I. General information

NPI: 1881626349
Provider Name (Legal Business Name): BRENDA KAY ZAGULA M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA KAY SCHUMACHER M.P.T.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N SEYMOUR AVE
MUNDELEIN IL
60060-1835
US

IV. Provider business mailing address

1026 WRENS GATE
MUNDELEIN IL
60060-1268
US

V. Phone/Fax

Practice location:
  • Phone: 847-949-4262
  • Fax: 847-949-8526
Mailing address:
  • Phone: 847-949-4262
  • Fax: 847-949-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: