Provider Demographics
NPI:1396920443
Name:ZACHARIAH, RON (DPT, GCOMPT, CLT)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:ZACHARIAH
Suffix:
Gender:M
Credentials:DPT, GCOMPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31370 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082
Mailing Address - Country:US
Mailing Address - Phone:586-285-0545
Mailing Address - Fax:586-279-1700
Practice Address - Street 1:HORIZON MEDICAL BUILDING
Practice Address - Street 2:13251 E TEN MILE ROAD SUITE 400
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-759-7474
Practice Address - Fax:586-759-7476
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013556OtherBOARD OF PHYSICAL THERAPY