Provider Demographics
NPI:1295235026
Name:FIRESHEETS, ZACKERY (PTA)
Entity type:Individual
Prefix:
First Name:ZACKERY
Middle Name:
Last Name:FIRESHEETS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 UNIVERSITY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3645
Mailing Address - Country:US
Mailing Address - Phone:804-716-1527
Mailing Address - Fax:804-716-1563
Practice Address - Street 1:2422 UNIVERSITY PARK BLVD.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-716-1527
Practice Address - Fax:804-716-1563
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant