Healthcare Provider Details

I. General information

NPI: 1962771857
Provider Name (Legal Business Name): ZACHARY ALEXANDER CUPPLES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 S RAINBOW BLVD STE 151
LAS VEGAS NV
89139-6483
US

IV. Provider business mailing address

4858 E BASELINE RD SUITE 107
MESA AZ
85206-4638
US

V. Phone/Fax

Practice location:
  • Phone: 702-706-3846
  • Fax:
Mailing address:
  • Phone: 480-807-6500
  • Fax: 480-897-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004933
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070018983
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10973
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4212
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: