Provider Demographics
NPI:1255805529
Name:EDWARDS, ZACHARY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 OAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-8747
Mailing Address - Country:US
Mailing Address - Phone:814-279-4049
Mailing Address - Fax:
Practice Address - Street 1:289 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1342
Practice Address - Country:US
Practice Address - Phone:818-630-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0057742255A2300X
MDA00006522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer