Provider Demographics
NPI:1821175357
Name:CORIELL, ZACHARY LANE (PT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LANE
Last Name:CORIELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 CORIELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9085
Mailing Address - Country:US
Mailing Address - Phone:740-981-7758
Mailing Address - Fax:
Practice Address - Street 1:8520 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1874
Practice Address - Country:US
Practice Address - Phone:740-981-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13509225100000X
OHPT13509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist