Healthcare Provider Details

I. General information

NPI: 1205474947
Provider Name (Legal Business Name): KARYN ZAAGE DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 11/01/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON ST
FORT SILL OK
73503-4472
US

IV. Provider business mailing address

4076 NEELY RD
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-3421
  • Fax:
Mailing address:
  • Phone: 907-361-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1312846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: