Provider Demographics
NPI:1558705400
Name:MALIN, ZACHARY A (MAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:A
Last Name:MALIN
Suffix:
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3403
Mailing Address - Country:US
Mailing Address - Phone:440-371-1993
Mailing Address - Fax:
Practice Address - Street 1:4333 LINDA DR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3403
Practice Address - Country:US
Practice Address - Phone:440-371-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer