Healthcare Provider Details

I. General information

NPI: 1033683792
Provider Name (Legal Business Name): ZACHARY ALLEN BERGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 HIGHWAY 231 S STE 2
TROY AL
36081-3027
US

IV. Provider business mailing address

6016 COLEMAN LAKE RD
MC CALLA AL
35111-3200
US

V. Phone/Fax

Practice location:
  • Phone: 334-465-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1975
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: