Healthcare Provider Details

I. General information

NPI: 1407285810
Provider Name (Legal Business Name): STEVEN ZOOK MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 GATWICK VIEW DR
FISHERS IN
46037-4169
US

IV. Provider business mailing address

11911 GATWICK VIEW DR
FISHERS IN
46037-4169
US

V. Phone/Fax

Practice location:
  • Phone: 317-418-0021
  • Fax:
Mailing address:
  • Phone: 317-418-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: