Provider Demographics
NPI:1700189917
Name:WEBER, ZACHARY (CP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-7902
Mailing Address - Country:US
Mailing Address - Phone:865-297-6600
Mailing Address - Fax:
Practice Address - Street 1:4444 KEYSTONE DR STE F
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-8796
Practice Address - Country:US
Practice Address - Phone:419-401-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN175224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist