Provider Demographics
NPI:1558770685
Name:COOPER, ZACH
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MICHIGAN AVE STE 973W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2218
Mailing Address - Country:US
Mailing Address - Phone:312-651-6255
Mailing Address - Fax:
Practice Address - Street 1:845 N MICHIGAN AVE STE 973W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2218
Practice Address - Country:US
Practice Address - Phone:312-651-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.016384225700000X
IL0700269142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist