Provider Demographics
NPI:1902264864
Name:STANTON, ZAKARY (AT,ATC,SCAT)
Entity Type:Individual
Prefix:
First Name:ZAKARY
Middle Name:
Last Name:STANTON
Suffix:
Gender:M
Credentials:AT,ATC,SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 32ND AVENUE SOUTH
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582
Mailing Address - Country:US
Mailing Address - Phone:330-442-2029
Mailing Address - Fax:
Practice Address - Street 1:301 LORIS LIONS RD
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-5004
Practice Address - Country:US
Practice Address - Phone:843-380-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1730390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program