Healthcare Provider Details

I. General information

NPI: 1962467027
Provider Name (Legal Business Name): CAROL J ZWEIFEL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON STATE UNIVERSITY PEB 122
PULLMAN WA
99164-0001
US

IV. Provider business mailing address

1185 GUERNSEY CUT OFF
POTLATCH ID
83855-9649
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-0307
  • Fax: 509-335-4594
Mailing address:
  • Phone: 208-875-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

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: