Individual
ZACHARIAH MIHALOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
13585 WAYLON LN, MANASSAS, VA 20112-3677
(571) 264-4693
Mailing address
13586 WAYLON LN, MANASSAS, VA 20112-3677
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
02126003644
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/16/2021
Last updated
05/08/2022
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