Provider Demographics
NPI:1154655173
Name:ZACOUR, SARAH ELISHA (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISHA
Last Name:ZACOUR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELISHA
Other - Last Name:JUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3373 COMMERCE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7130
Mailing Address - Country:US
Mailing Address - Phone:330-804-9712
Mailing Address - Fax:330-804-9717
Practice Address - Street 1:3373 COMMERCE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7130
Practice Address - Country:US
Practice Address - Phone:330-804-9712
Practice Address - Fax:330-804-9717
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.012523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3004242Medicaid
OH3004242Medicaid