Provider Demographics
NPI:1447619531
Name:ZELLNER, EDWARD (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 DAISY CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9342
Mailing Address - Country:US
Mailing Address - Phone:610-366-1461
Mailing Address - Fax:
Practice Address - Street 1:500 MACUNGIE AVE
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049
Practice Address - Country:US
Practice Address - Phone:610-965-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001700A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer