Provider Demographics
NPI:1689703969
Name:ZACCAGNINI, ROBERT RAYMOND (MS, ATC, EMT-B)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAYMOND
Last Name:ZACCAGNINI
Suffix:
Gender:M
Credentials:MS, ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E PATTY LN
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3615
Mailing Address - Country:US
Mailing Address - Phone:412-380-0533
Mailing Address - Fax:
Practice Address - Street 1:221 E PATTY LN
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3615
Practice Address - Country:US
Practice Address - Phone:412-380-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001256A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer