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General NPI Number Information
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NPI Number | 1023569050
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Entity Type | Individual
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Provider Name | ZACHARY FERRIS ATC
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1001 CHERRY BLOSSOM WAY
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City | GEORGETOWN
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State | KY
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Zip | 40324-9564
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Country | US
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Telephone | 502-868-3854
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 WYATT PKWY
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City | LEXINGTON
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State | KY
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Zip | 40505-4031
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Country | US
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Telephone | 859-455-6801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1060
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License Number State | KY
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