Healthcare Provider Details

I. General information

NPI: 1841074168
Provider Name (Legal Business Name): KEYU ZHUANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 MASSACHUSETTS AVE
BOSTON MA
02115-3004
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 617-399-7330
  • Fax: 617-399-7331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL27093
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: