Provider Demographics
NPI:1336400886
Name:ZACHARIAH, BOBBY KOREZ
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:KOREZ
Last Name:ZACHARIAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROY CT SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-6170
Mailing Address - Country:US
Mailing Address - Phone:586-215-8990
Mailing Address - Fax:
Practice Address - Street 1:315 DRY MILL RD SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2601
Practice Address - Country:US
Practice Address - Phone:586-215-8990
Practice Address - Fax:703-737-2130
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012722225100000X
VA2305205659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist