Provider Demographics
NPI:1528615069
Name:SCHRADER, ZACHARY JOHN (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JOHN
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 TWIN SILO DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-4202
Mailing Address - Country:US
Mailing Address - Phone:215-661-1184
Mailing Address - Fax:
Practice Address - Street 1:9000 TWIN SILO DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-4202
Practice Address - Country:US
Practice Address - Phone:215-661-1184
Practice Address - Fax:215-699-6201
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014724225100000X
PART0073372255A2300X
PAPT031353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer