Provider Demographics
NPI:1043736325
Name:MERRITT, ZACHARY SCOTT
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SCOTT
Last Name:MERRITT
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 1:755 MOSE ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-8569
Mailing Address - Country:US
Mailing Address - Phone:304-544-2472
Mailing Address - Fax:
Practice Address - Street 1:590 N POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-7106
Practice Address - Country:US
Practice Address - Phone:304-757-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002271225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant