Provider Demographics
NPI:1275949125
Name:SMITHEMAN, ZACHARY (ATC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:SMITHEMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2248
Mailing Address - Country:US
Mailing Address - Phone:610-721-8144
Mailing Address - Fax:
Practice Address - Street 1:643 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2248
Practice Address - Country:US
Practice Address - Phone:610-721-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA004142255A2300X
DEJ3-00004632255A2300X
PART0052762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer