Provider Demographics
NPI:1548786270
Name:ALLEN, ZACHARY LANCE (ATC , MBA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LANCE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:ATC , MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BLOWERS BLVD
Practice Address - Street 2:
Practice Address - City:MILLIGAN COLLEGE
Practice Address - State:TN
Practice Address - Zip Code:37682
Practice Address - Country:US
Practice Address - Phone:423-461-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000014622083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine