Healthcare Provider Details

I. General information

NPI: 1134423809
Provider Name (Legal Business Name): THOMAS W ZAUCHA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE 119 PROFESSIONAL CENTER, SUITE 312
INDIANA PA
15701-3501
US

IV. Provider business mailing address

9 N 7TH ST 2ND FLOOR, TOWNPLACE VICTORIA
INDIANA PA
15701-1880
US

V. Phone/Fax

Practice location:
  • Phone: 724-801-8894
  • Fax: 724-465-6032
Mailing address:
  • Phone: 724-801-8894
  • Fax: 724-465-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT002307L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: