Provider Demographics
NPI:1780219543
Name:ZAK, PHILLIP
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:ZAK
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 1:7725 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5371
Mailing Address - Country:US
Mailing Address - Phone:440-232-7725
Mailing Address - Fax:
Practice Address - Street 1:14900 PRIVATE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3470
Practice Address - Country:US
Practice Address - Phone:216-851-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist