Provider Demographics
NPI:1588037121
Name:ZAPPA, FRED ANTHONY III
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:ANTHONY
Last Name:ZAPPA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6695 CLEARWATER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55038-7705
Mailing Address - Country:US
Mailing Address - Phone:651-895-4133
Mailing Address - Fax:
Practice Address - Street 1:6695 CLEARWATER CREEK DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55038-7705
Practice Address - Country:US
Practice Address - Phone:651-895-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer