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General NPI Number Information
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NPI Number | 1538518006
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Entity Type | Individual
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Provider Name | ZACHARY LEWIS MAT, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 13655 BRONCOS PKWY
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City | ENGLEWOOD
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State | CO
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Zip | 80112-4150
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Country | US
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Telephone | 720-338-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 5355 E BRIARWOOD CIR
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City | CENTENNIAL
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State | CO
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Zip | 80122-2315
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Country | US
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Telephone |
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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 | AT.0001404
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License Number State | CO
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