Healthcare Provider Details

I. General information

NPI: 1780503680
Provider Name (Legal Business Name): RALPH ZACHARY OVERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ALBER ST
WABASH IN
46992-1015
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-569-5480
  • Fax: 260-569-5485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010556A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: