Provider Demographics
NPI:1811762214
Name:WANNER, ZACHARY WAYNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:WAYNE
Last Name:WANNER
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 1:700 WARNER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERTON
Mailing Address - State:PA
Mailing Address - Zip Code:16936-9502
Mailing Address - Country:US
Mailing Address - Phone:484-772-0794
Mailing Address - Fax:
Practice Address - Street 1:700 WARNER RD
Practice Address - Street 2:
Practice Address - City:MILLERTON
Practice Address - State:PA
Practice Address - Zip Code:16936-9502
Practice Address - Country:US
Practice Address - Phone:484-772-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist