Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1073091906 |
---|---|
Provider Name | Zachary Jeznach |
First Address | Plymouth Meeting, PA 19462-1420 |
Second Address | Philadelphia, PA 19106-3323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 02/08/2018 |