Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 016498 | OH |
N | 2251S0007X | Physical Therapist - Sports | 016498 | OH |
Y | 2251X0800X | Physical Therapist - Orthopedic | 016498 | OH |
NPI | 1114415916 |
---|---|
Provider Name | Zachary Poreda |
First Address | Chagrin Falls, OH 44022-3026 |
Second Address | Chagrin Falls, OH 44022-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 11/01/2022 |