Provider Demographics
NPI:1164268967
Name:ZACHO, TYLER JAMES (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:ZACHO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:WI
Mailing Address - Zip Code:53923-0034
Mailing Address - Country:US
Mailing Address - Phone:920-319-2213
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 34
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:WI
Practice Address - Zip Code:53923-0034
Practice Address - Country:US
Practice Address - Phone:920-319-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16814-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist