Healthcare Provider Details

I. General information

NPI: 1457895773
Provider Name (Legal Business Name): ZACHARY HERR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ZACH HERR PTA

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10118 MAPLE ST
OMAHA NE
68134-5555
US

IV. Provider business mailing address

1702 S 61ST AVE
OMAHA NE
68106-2110
US

V. Phone/Fax

Practice location:
  • Phone: 402-939-7939
  • Fax:
Mailing address:
  • Phone: 402-990-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number26-2054839
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: