Basic Information
| Provider Information | |||||||||
| NPI: | 1215563580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOWNEY | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 N 7TH ST APT A-1 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180131743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099691972 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2030 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180208963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2020 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 25MT00253900 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | RT007199 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.