Provider Demographics
NPI:1871634584
Name:ZACK, KIMBERLY JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:ZACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:530 N HOUGH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3087
Practice Address - Country:US
Practice Address - Phone:847-381-0090
Practice Address - Fax:847-381-0181
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist