MEDICARE: KELLIE B ZINSKI ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	ATR-001587	AZ

General Provider Information

NPI Number	:	1235749474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE B ZINSKI ATC

Provider Business Mailing Address
First Line	:	7050 S 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5806
Country	:	US
Telephone Number	:	906-201-0584
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 S 24TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5806
Country	:	US
Telephone Number	:	602-243-8232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	06/09/2026

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