Provider Demographics
NPI:1912465816
Name:CROTHERS, ZACHARY (ATC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:CROTHERS
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 1:402 BUFORD ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-2228
Mailing Address - Country:US
Mailing Address - Phone:810-210-6394
Mailing Address - Fax:
Practice Address - Street 1:2703 LEGENDS PKWY
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7755
Practice Address - Country:US
Practice Address - Phone:810-210-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010011782255A2300X
AL18922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer