Provider Demographics
NPI:1891177598
Name:OVERGAARD, ZACH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:OVERGAARD
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 1:9777 S YOSEMITE ST
Mailing Address - Street 2:130
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3191
Mailing Address - Country:US
Mailing Address - Phone:303-333-3493
Mailing Address - Fax:
Practice Address - Street 1:9777 S YOSEMITE ST
Practice Address - Street 2:130
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3191
Practice Address - Country:US
Practice Address - Phone:303-333-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist