Provider Demographics
NPI:1871857094
Name:ZEN TANTRA WELLNESS CENTER
Entity Type:Organization
Organization Name:ZEN TANTRA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENOBIA
Authorized Official - Middle Name:ZUBIN
Authorized Official - Last Name:TANTRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-219-6278
Mailing Address - Street 1:2426 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8306
Mailing Address - Country:US
Mailing Address - Phone:847-219-6278
Mailing Address - Fax:846-229-0141
Practice Address - Street 1:1475 E BELVIDERE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2012
Practice Address - Country:US
Practice Address - Phone:847-219-6278
Practice Address - Fax:846-229-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010743261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy