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General NPI Number Information
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NPI Number | 1891217683
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Entity Type | Individual
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Provider Name | ZACHARY MICHAEL STAPLETON DPT
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Gender | Male
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE # W107
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-6891
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Fax |
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Provider Business Mailing Address
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Address Line | 10S170 SUFFIELD DR
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-5194
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Country | US
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Telephone | 16305427354
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT292035
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070.022317
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License Number State | IL
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