Provider Demographics
NPI:1326131327
Name:TANTRA, ZENOBIA Z (PT)
Entity Type:Individual
Prefix:MRS
First Name:ZENOBIA
Middle Name:Z
Last Name:TANTRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E ROLLINS ROAD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1331
Mailing Address - Country:US
Mailing Address - Phone:847-201-7612
Mailing Address - Fax:847-201-7613
Practice Address - Street 1:301 E ROLLINS ROAD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1331
Practice Address - Country:US
Practice Address - Phone:847-201-7612
Practice Address - Fax:847-201-7613
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL76762Medicare UPIN
ILL72298Medicare UPIN