MEDICARE: MR. JOHN CARL ZATORSKI JR. RPT

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	225100000X	Physical Therapist	PT16359	FL

General Provider Information

NPI Number	:	1699788323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CARL ZATORSKI JR. RPT

Provider Business Mailing Address
First Line	:	4022 N OCEAN BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6420
Country	:	US
Telephone Number	:	954-566-2400
Fax Number	:	954-566-2409

Provider Business Practice Location Address
First Line	:	4022 N OCEAN BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6420
Country	:	US
Telephone Number	:	954-566-2400
Fax Number	:	954-566-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/01/2010

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