Healthcare Provider Details

I. General information

NPI: 1164259883
Provider Name (Legal Business Name): ISABELLE ZUKAITIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12228 ITTA BENA RD
MEADOWVIEW VA
24361
US

IV. Provider business mailing address

500 GILLS CREEK PKWY APT 1505
COLUMBIA SC
29209-1240
US

V. Phone/Fax

Practice location:
  • Phone: 276-944-6835
  • Fax:
Mailing address:
  • Phone: 913-222-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: