Healthcare Provider Details

I. General information

NPI: 1548644743
Provider Name (Legal Business Name): ZACHERY THOMAS RICHARDS MS, SCAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LYDIA DR
PELION SC
29123-9812
US

IV. Provider business mailing address

1051 SOUTHERN DR UNIT 3113
COLUMBIA SC
29201-5631
US

V. Phone/Fax

Practice location:
  • Phone: 803-821-2258
  • Fax:
Mailing address:
  • Phone: 413-652-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: