Provider Demographics
NPI:1588124002
Name:EGOLF, ZACHARY JAMES (PTA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:EGOLF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 DAVE RILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2531
Mailing Address - Country:US
Mailing Address - Phone:443-974-3359
Mailing Address - Fax:
Practice Address - Street 1:7200 THIRD AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5205
Practice Address - Country:US
Practice Address - Phone:410-795-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5117225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant