Provider Demographics
NPI:1548705569
Name:BRIGHAM, ZACHERY J (MS, ATC, LAT, CES)
Entity type:Individual
Prefix:MR
First Name:ZACHERY
Middle Name:J
Last Name:BRIGHAM
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 STANGE RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4017
Mailing Address - Country:US
Mailing Address - Phone:517-474-8425
Mailing Address - Fax:
Practice Address - Street 1:1822 S 4TH ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-9641
Practice Address - Country:US
Practice Address - Phone:517-474-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1012302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer