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General NPI Number Information
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NPI Number | 1871857094
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Entity Type | Organization
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Legal Business Name | ZEN TANTRA WELLNESS CENTER
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 1475 E BELVIDERE RD SUITE 216
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2012
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Country | US
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Telephone | 847-219-6278
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Fax | 846-229-0141
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Provider Business Mailing Address
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Address Line | 2426 RFD
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City | LONG GROVE
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State | IL
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Zip | 60047-8306
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Country | US
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Telephone | 847-219-6278
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Fax | 846-229-0141
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. ZENOBIA ZUBIN TANTRA
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Credential | PT
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Telephone | 847-219-6278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070-010743
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License Number State | IL
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