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General NPI Number Information
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NPI Number | 1811594856
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Entity Type | Individual
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Provider Name | ZACHARY A. MCENTEE ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 7111 AURORA AVE
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City | URBANDALE
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State | IA
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Zip | 50322-1741
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Country | US
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Telephone | 515-975-6271
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Fax |
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Provider Business Mailing Address
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Address Line | 8601 WESTOWN PKWY UNIT 11103
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City | WEST DES MOINES
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State | IA
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Zip | 50266-1627
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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 | 089110
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License Number State | IA
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