Provider Demographics
NPI:1770709750
Name:ZEMECKIS, LOREN ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:ANN
Last Name:ZEMECKIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11741 S ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2155
Mailing Address - Country:US
Mailing Address - Phone:773-817-0617
Mailing Address - Fax:
Practice Address - Street 1:6775 PROSPERI DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4789
Practice Address - Country:US
Practice Address - Phone:708-429-1260
Practice Address - Fax:708-429-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant