Provider Demographics
NPI:1699177923
Name:MISHOE, ZACH HARMON (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:HARMON
Last Name:MISHOE
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:ZACHARY
Other - Middle Name:HARMON
Other - Last Name:MISHOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:601 S COLLEGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5913
Mailing Address - Country:US
Mailing Address - Phone:910-962-2497
Mailing Address - Fax:
Practice Address - Street 1:601 S COLLEGE ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5913
Practice Address - Country:US
Practice Address - Phone:910-962-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer