Basic Information
| Provider Information | |||||||||
| NPI: | 1700820834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZINK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FENTON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | A.T.,C. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ZINK | ||||||||
| OtherFirstName: | SHAWN | ||||||||
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| OtherCredential: | A.T.,C. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 186 SUMTER SQ | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299105726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437572020 | ||||||||
| FaxNumber: | 8437572020 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MATHEWS DR | ||||||||
| Address2: | SUITE D5 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299263734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436815640 | ||||||||
| FaxNumber: | 8436815631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 154 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.