Provider Demographics
NPI:1023848207
Name:KINGSTON, ZACHARY T (ATC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:T
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SPRING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7515
Mailing Address - Country:US
Mailing Address - Phone:309-242-3788
Mailing Address - Fax:
Practice Address - Street 1:343 WINDING WOODS CTR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4170
Practice Address - Country:US
Practice Address - Phone:636-439-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer