Provider Demographics
NPI:1457895773
Name:HERR, ZACHARY
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:HERR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZACH
Other - Middle Name:
Other - Last Name:HERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1702 S 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2110
Mailing Address - Country:US
Mailing Address - Phone:402-990-4236
Mailing Address - Fax:
Practice Address - Street 1:10118 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5555
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26-2054839261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy