Healthcare Provider Details

I. General information

NPI: 1891244521
Provider Name (Legal Business Name): ZACHARY RYAN HOBSON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 S WASHINGTON ST
MARION IN
46953-4974
US

IV. Provider business mailing address

569 W 500 N
MARION IN
46952-9730
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-6901
  • Fax:
Mailing address:
  • Phone: 260-571-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36003588A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: