Provider Demographics
NPI:1417040411
Name:TANTRA, ZUBIN S (PT, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:ZUBIN
Middle Name:S
Last Name:TANTRA
Suffix:
Gender:M
Credentials:PT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E HAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2419
Mailing Address - Country:US
Mailing Address - Phone:847-543-7604
Mailing Address - Fax:847-543-7605
Practice Address - Street 1:511 E HAWLEY ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2419
Practice Address - Country:US
Practice Address - Phone:847-543-7604
Practice Address - Fax:847-543-7605
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-006952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL76761Medicare UPIN
ILL72297Medicare UPIN