Healthcare Provider Details

I. General information

NPI: 1689703969
Provider Name (Legal Business Name): ROBERT RAYMOND ZACCAGNINI MS, ATC, EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E PATTY LN
MONROEVILLE PA
15146-3615
US

IV. Provider business mailing address

221 E PATTY LN
MONROEVILLE PA
15146-3615
US

V. Phone/Fax

Practice location:
  • Phone: 412-380-0533
  • Fax:
Mailing address:
  • Phone: 412-380-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001256A
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: