Provider Demographics
NPI:1578035051
Name:ZAHNTER, MARIAH R (PTA)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:R
Last Name:ZAHNTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:BONNOTS MILL
Mailing Address - State:MO
Mailing Address - Zip Code:65016-2140
Mailing Address - Country:US
Mailing Address - Phone:573-826-0040
Mailing Address - Fax:
Practice Address - Street 1:1720 VIETH DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2056
Practice Address - Country:US
Practice Address - Phone:573-635-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017036682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant