MEDICARE: GERLANDO ZAMBUTO DC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	23765	FL
2	111N00000X	Chiropractor	CH8668	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89471	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396057204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERLANDO ZAMBUTO DC LLC

Provider Business Mailing Address
First Line	:	2040 NE 49TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4524
Country	:	US
Telephone Number	:	954-493-8875
Fax Number	:	954-493-8876

Provider Business Practice Location Address
First Line	:	2040 NE 49TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4524
Country	:	US
Telephone Number	:	954-493-8875
Fax Number	:	954-493-8876

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. GERLANDO ZAMBUTO
Credential	:	D.C.
Telephone Number	:	954-493-8875

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	04/14/2011

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