Provider Demographics
NPI:1184406423
Name:VIDUYA, ZACHARY ROBERT (DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ROBERT
Last Name:VIDUYA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:14660 HERRIMAN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4869
Practice Address - Country:US
Practice Address - Phone:317-774-7744
Practice Address - Fax:317-774-7755
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist