Healthcare Provider Details

I. General information

NPI: 1518821347
Provider Name (Legal Business Name): ZACH JAMES DECAMP I PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LIBERTY WAY
GAHANNA OH
43230-3502
US

IV. Provider business mailing address

4949 GREENGATE DR
GROVEPORT OH
43125-9753
US

V. Phone/Fax

Practice location:
  • Phone: 614-460-0647
  • Fax:
Mailing address:
  • Phone: 614-460-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA012793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: