1831616739 NPI number — MR. ZACHARY DAVID HOWELL LAT, ATC

Table of content: MR. ZACHARY DAVID HOWELL LAT, ATC (NPI 1831616739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831616739 NPI number — MR. ZACHARY DAVID HOWELL LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWELL
Provider First Name:
ZACHARY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831616739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 LASALLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINSVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62234-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-973-8090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 BELT LINE RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLINSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62234-4489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-477-8550
Provider Business Practice Location Address Fax Number:
618-477-8551
Provider Enumeration Date:
08/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2017025263 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: 096004486 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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