Provider Demographics
NPI:1205202496
Name:MINTON, ZACHARY WAYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WAYNE
Last Name:MINTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1326
Mailing Address - Country:US
Mailing Address - Phone:404-762-1001
Mailing Address - Fax:404-762-1007
Practice Address - Street 1:1005 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1326
Practice Address - Country:US
Practice Address - Phone:404-762-1001
Practice Address - Fax:404-762-1007
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012042225100000X
SC7773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist