Provider Demographics
NPI:1962987099
Name:WORTHINGTON, ZACHARY SCOTT (CPO)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SCOTT
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LATOUCHE ST # 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4208
Mailing Address - Country:US
Mailing Address - Phone:907-561-1777
Mailing Address - Fax:907-561-2157
Practice Address - Street 1:3400 LATOUCHE ST # 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4208
Practice Address - Country:US
Practice Address - Phone:907-561-1777
Practice Address - Fax:907-561-2157
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty