Healthcare Provider Details

I. General information

NPI: 1750748844
Provider Name (Legal Business Name): SYDNEY ZWART MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 DONNINGTON TER
KALAMAZOO MI
49006-2612
US

IV. Provider business mailing address

1021 DONNINGTON TER
KALAMAZOO MI
49006-2612
US

V. Phone/Fax

Practice location:
  • Phone: 269-760-1462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: