Individual
ZACHARY DAVID BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(636) 290-1136
Mailing address
2907 CANTERBURY BLVD APT 5, FORT WAYNE, IN 46835-3238
(636) 290-1136
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36002937A
ATHLETIC TRAINING
IN
Enumeration date
01/18/2018
Last updated
01/18/2018
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