Provider Demographics
NPI:1447594734
Name:IASILLI, ZOE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:IASILLI
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-3668
Mailing Address - Country:US
Mailing Address - Phone:802-598-9799
Mailing Address - Fax:
Practice Address - Street 1:2806 ARBOR DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-3668
Practice Address - Country:US
Practice Address - Phone:802-598-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT923650852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer