Provider Demographics
NPI:1881626349
Name:ZAGULA, BRENDA KAY (MPT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:ZAGULA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1026 WRENS GATE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1268
Mailing Address - Country:US
Mailing Address - Phone:847-949-4262
Mailing Address - Fax:847-949-8526
Practice Address - Street 1:450 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1835
Practice Address - Country:US
Practice Address - Phone:847-949-4262
Practice Address - Fax:847-949-8526
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932224OtherBLUE CROSS & BLUE SHIELD
IL7308603OtherAETNA
IL4069841OtherCIGNA
IL4932224OtherBLUE CROSS & BLUE SHIELD