Healthcare Provider Details

I. General information

NPI: 1730906686
Provider Name (Legal Business Name): ZACHARY VAN DORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13875 W 115TH TER
OLATHE KS
66062-7937
US

IV. Provider business mailing address

8477 S SUNCOAST BLVD
HOMOSASSA FL
34446-5028
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-0822
  • Fax:
Mailing address:
  • Phone: 800-381-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07665
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: