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General NPI Number Information
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NPI Number | 1952722902
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Entity Type | Individual
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Provider Name | JACOB ZANGER DPT
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 17300 N OUTER 40 RD STE 202
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1364
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Country | US
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Telephone | 217-430-1530
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Fax | 636-728-1793
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Provider Business Mailing Address
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Address Line | 3120 CANNONBALL RD
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City | QUINCY
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State | IL
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Zip | 62305-7640
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070020454
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2014011103
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License Number State | MO
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