Provider Demographics
NPI:1548284300
Name:STUBBLEFIELD, ZEVON M (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ZEVON
Middle Name:M
Last Name:STUBBLEFIELD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N 58TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1531
Mailing Address - Country:US
Mailing Address - Phone:754-264-9154
Mailing Address - Fax:
Practice Address - Street 1:3301 COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-7796
Practice Address - Country:US
Practice Address - Phone:754-264-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 17292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer