Provider Demographics
NPI:1588309926
Name:MACKLIN, ZACHARY EDWARD (ATC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:EDWARD
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 LAKE SHORE RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-0141
Mailing Address - Country:US
Mailing Address - Phone:336-662-3910
Mailing Address - Fax:
Practice Address - Street 1:1600 BREWER RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3857
Practice Address - Country:US
Practice Address - Phone:336-408-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-26262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer