Healthcare Provider Details

I. General information

NPI: 1760306401
Provider Name (Legal Business Name): JACOB ZARNOSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 BEACON PKWY
GRANGER IN
46530-7196
US

IV. Provider business mailing address

1206 S 29TH ST
SOUTH BEND IN
46615-1806
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-3547
  • Fax:
Mailing address:
  • Phone: 574-647-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: