MEDICARE: ZACHARY A. MCENTEE ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	089110	IA

General Provider Information

NPI Number	:	1811594856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY A. MCENTEE ATC, LAT

Provider Business Mailing Address
First Line	:	8601 WESTOWN PKWY UNIT 11103
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 AURORA AVE
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-1741
Country	:	US
Telephone Number	:	515-975-6271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	10/02/2020

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