Provider Demographics
NPI:1700173374
Name:SKAGGS, ZACHARY LEE (PT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LEE
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SE RHINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2853
Mailing Address - Country:US
Mailing Address - Phone:503-895-1320
Mailing Address - Fax:503-296-2319
Practice Address - Street 1:1705 SE RHINE ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2853
Practice Address - Country:US
Practice Address - Phone:503-895-1320
Practice Address - Fax:503-296-2319
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist