Healthcare Provider Details

I. General information

NPI: 1225705429
Provider Name (Legal Business Name): ANTHONY MICHAEL ZATTO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FOXFIELD RD STE 100
ST CHARLES IL
60174-5799
US

IV. Provider business mailing address

2900 FOXFIELD RD STE 100
ST CHARLES IL
60174-5799
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.009324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: