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General NPI Number Information
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NPI Number | 1114416732
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Entity Type | Individual
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Provider Name | STEPHEN TODD ZACHARY DPT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 4615 HIGHWAY 80 STE 9
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City | HAUGHTON
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State | LA
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Zip | 71037-7480
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Country | US
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Telephone | 318-615-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 3203 HANOVER CT
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City | BOSSIER CITY
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State | LA
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Zip | 71111-8167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 09079R
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License Number State | LA
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