Healthcare Provider Details

I. General information

NPI: 1871486696
Provider Name (Legal Business Name): JIAZE ZHU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 GRANVILLE RD
NEWARK OH
43055-1582
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 740-321-1021
  • Fax:
Mailing address:
  • Phone: 630-575-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021762
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: