Healthcare Provider Details

I. General information

NPI: 1114415916
Provider Name (Legal Business Name): ZACHARY POREDA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W WASHINGTON ST
CHAGRIN FALLS OH
44022-3026
US

IV. Provider business mailing address

2546 CENTER RD
HINCKLEY OH
44233-9561
US

V. Phone/Fax

Practice location:
  • Phone: 440-247-2644
  • Fax:
Mailing address:
  • Phone: 330-558-0100
  • Fax: 330-558-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number016498
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number016498
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number016498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: