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General NPI Number Information
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NPI Number | 1760251433
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Entity Type | Individual
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Provider Name | ZACHARY BRANDEN ELERY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 9735 SOUTHWEST HWY
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City | OAK LAWN
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State | IL
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Zip | 60453-3614
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Country | US
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Telephone | 708-499-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 18320 ANTHONY AVE
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-5236
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Country | US
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Telephone | 708-704-9952
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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 | 070.027980
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License Number State | IL
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