Healthcare Provider Details

I. General information

NPI: 1649798034
Provider Name (Legal Business Name): MR. ZACHARY JOHN BAYNHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PUMPKIN CENTER RD
FINLEYVILLE PA
15332
US

IV. Provider business mailing address

43 PUMPKIN CENTER RD
FINLEYVILLE PA
15332-3106
US

V. Phone/Fax

Practice location:
  • Phone: 412-799-8993
  • Fax:
Mailing address:
  • Phone: 412-799-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: