Provider Demographics
NPI:1497546949
Name:PACKER, ZAC (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ZAC
Middle Name:
Last Name:PACKER
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 1:4625 TRAIL BOSS DR STE F
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2803
Mailing Address - Country:US
Mailing Address - Phone:208-243-4832
Mailing Address - Fax:
Practice Address - Street 1:4625 TRAIL BOSS DR STE F
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2803
Practice Address - Country:US
Practice Address - Phone:208-243-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist