Provider Demographics
NPI:1265716104
Name:MERTZ, ZACHARY
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:MERTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S HAM LN STE B
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3532
Mailing Address - Country:US
Mailing Address - Phone:209-368-7433
Mailing Address - Fax:209-222-6182
Practice Address - Street 1:631 S HAM LN STE B
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3532
Practice Address - Country:US
Practice Address - Phone:209-368-7433
Practice Address - Fax:209-222-6182
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist