Provider Demographics
NPI:1760893663
Name:ZAHRADKA, LARRY GREGG (ATC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GREGG
Last Name:ZAHRADKA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8178
Mailing Address - Country:US
Mailing Address - Phone:701-541-2266
Mailing Address - Fax:701-356-1051
Practice Address - Street 1:1050 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8178
Practice Address - Country:US
Practice Address - Phone:701-541-2266
Practice Address - Fax:701-356-1051
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND213-992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer