Healthcare Provider Details

I. General information

NPI: 1528925252
Provider Name (Legal Business Name): ZACHARY PHILLIPS ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1381
US

IV. Provider business mailing address

7000 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1381
US

V. Phone/Fax

Practice location:
  • Phone: 606-539-4126
  • Fax:
Mailing address:
  • Phone: 606-539-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2350
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: