Provider Demographics
NPI:1114160314
Name:ZEHAR, BRYAN M (PTA)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:ZEHAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 FOREST HILLS RD
Mailing Address - Street 2:PHYSICIANS IMMEDIATE CARE
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8234
Mailing Address - Country:US
Mailing Address - Phone:815-713-2738
Mailing Address - Fax:815-282-8597
Practice Address - Street 1:1360 HOUBOLT ROAD
Practice Address - Street 2:PHYSICIANS IMMEDIATE CARE/NORTH CHICAGO LLC
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9215
Practice Address - Country:US
Practice Address - Phone:815-823-8800
Practice Address - Fax:815-729-2178
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL160005150225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213992Medicare PIN
IL204591Medicare PIN