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General NPI Number Information
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NPI Number | 1821626268
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Entity Type | Individual
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Provider Name | BRANNON ZOCHERT MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 12616 104TH ST
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-6100
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Country | US
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Telephone | 248-762-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 3335 ROCK RIDGE RD
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City | WEST BEND
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State | WI
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Zip | 53095-7600
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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 | 2379-39
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License Number State | WI
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