Provider Demographics
NPI:1164766515
Name:ZAVALA, MATTHEW (MPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:530 N HOUGH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3087
Practice Address - Country:US
Practice Address - Phone:847-381-0090
Practice Address - Fax:847-381-0181
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist