Healthcare Provider Details

I. General information

NPI: 1770709750
Provider Name (Legal Business Name): LOREN ANN ZEMECKIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 PROSPERI DR
TINLEY PARK IL
60477-4789
US

IV. Provider business mailing address

11741 S ROSEMARY LN
ALSIP IL
60803-2155
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-1260
  • Fax: 708-429-6622
Mailing address:
  • Phone: 773-817-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: