Provider Demographics
NPI:1952294779
Name:PACKER NEURODIAGNOSTICS, LLC
Entity type:Organization
Organization Name:PACKER NEURODIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAC
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-243-4832
Mailing Address - Street 1:4625 TRAIL BOSS DR STE F
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2803
Mailing Address - Country:US
Mailing Address - Phone:208-243-4832
Mailing Address - Fax:
Practice Address - Street 1:4625 TRAIL BOSS DR STE F
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2803
Practice Address - Country:US
Practice Address - Phone:208-243-4832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty