Provider Demographics
NPI:1063642387
Name:ERB, ZACHARY (PT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:ERB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MOONEY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2171
Mailing Address - Country:US
Mailing Address - Phone:815-933-7224
Mailing Address - Fax:815-933-7225
Practice Address - Street 1:110 MOONEY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2171
Practice Address - Country:US
Practice Address - Phone:815-933-7224
Practice Address - Fax:815-933-7225
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist