Provider Demographics
NPI:1790352458
Name:ZEBOLD, JAMES ROBERT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:ZEBOLD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7543 EXTON ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-6707
Mailing Address - Country:US
Mailing Address - Phone:630-956-0594
Mailing Address - Fax:
Practice Address - Street 1:6300 KINGERY HWY STE 204
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2326
Practice Address - Country:US
Practice Address - Phone:630-891-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist