Provider Demographics
NPI:1417634247
Name:STANDBACK, ZELLNER JONES
Entity Type:Individual
Prefix:
First Name:ZELLNER
Middle Name:JONES
Last Name:STANDBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZELLNER
Other - Middle Name:JONES
Other - Last Name:STANDBACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 901091
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38190-1091
Mailing Address - Country:US
Mailing Address - Phone:901-785-5878
Mailing Address - Fax:
Practice Address - Street 1:5180 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-6234
Practice Address - Country:US
Practice Address - Phone:901-785-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7LJGXNNLJS224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty