Provider Demographics
NPI:1871206946
Name:ZACHARIAS, KACEE LYNN
Entity type:Individual
Prefix:
First Name:KACEE
Middle Name:LYNN
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 1ST AVE NE APT B2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3968
Mailing Address - Country:US
Mailing Address - Phone:605-491-4408
Mailing Address - Fax:
Practice Address - Street 1:1103 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-3304
Practice Address - Country:US
Practice Address - Phone:605-432-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant