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General NPI Number Information
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NPI Number | 1144785361
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLAS ZITTEL SCAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 102 SALUDA POINTE DR
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City | LEXINGTON
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State | SC
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Zip | 29072-7295
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Country | US
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Telephone | 330-933-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 BENTLEY DR APT 422
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City | COLUMBIA
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State | SC
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Zip | 29210-7982
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Country | US
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Telephone | 330-933-2868
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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 | AT2857
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License Number State | SC
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