Basic Information
| Provider Information | |||||||||
| NPI: | 1114415916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POREDA | ||||||||
| FirstName: | ZACHARY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2546 CENTER RD | ||||||||
| Address2: | |||||||||
| City: | HINCKLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442339561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305580100 | ||||||||
| FaxNumber: | 3305580110 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CHAGRIN FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440223026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402472644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2018 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 016498 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 225100000X | 016498 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 016498 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.