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General NPI Number Information
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NPI Number | 1205313681
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Entity Type | Individual
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Provider Name | ZACHARY BRUCE MARTINDALE ATC
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Gender | Male
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 08/01/2021
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Provider Practice Location Address
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Address Line | 10850 W GARDEN LAKES PKWY
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City | AVONDALE
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State | AZ
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Zip | 85392-3799
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Country | US
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Telephone | 623-478-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 18542 W CARLOTA LN
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City | SURPRISE
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State | AZ
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Zip | 85387-1612
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Country | US
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Telephone | 760-646-2901
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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 |
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License Number State |
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