Provider Demographics
NPI:1740820802
Name:GANN, ZACHARY ANDREW (PTA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ANDREW
Last Name:GANN
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 1:177 PETERS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2810
Mailing Address - Country:US
Mailing Address - Phone:407-340-3483
Mailing Address - Fax:
Practice Address - Street 1:6311 DEBARR RD STE J
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1777
Practice Address - Country:US
Practice Address - Phone:907-231-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21721208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation