Provider Demographics
NPI:1831616739
Name:HOWELL, ZACHARY DAVID (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:DAVID
Last Name:HOWELL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2501
Mailing Address - Country:US
Mailing Address - Phone:618-973-8090
Mailing Address - Fax:
Practice Address - Street 1:1095 BELT LINE RD STE 400
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4489
Practice Address - Country:US
Practice Address - Phone:618-477-8550
Practice Address - Fax:618-477-8551
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170252632255A2300X
IL0960044862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer