Healthcare Provider Details

I. General information

NPI: 1144788878
Provider Name (Legal Business Name): RYAN MICHAEL ZAPPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 GOLF CLUB DR APT 5402
AUBURN AL
36830-5890
US

IV. Provider business mailing address

4315 GOLF CLUB DR APT 5402
AUBURN AL
36830-5890
US

V. Phone/Fax

Practice location:
  • Phone: 724-263-7221
  • Fax:
Mailing address:
  • Phone: 724-263-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2785
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT007733
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: