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General NPI Number Information
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NPI Number | 1689987935
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Entity Type | Individual
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Provider Name | SHERRI WYNN ZACK P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 95 CARLETON AVE
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5500
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Country | US
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Telephone | 360-469-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 BUCKINGHAM DR
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City | WHEATON
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State | IL
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Zip | 60189-8189
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Country | US
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Telephone | 630-665-1668
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070003293
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License Number State | IL
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