Healthcare Provider Details

I. General information

NPI: 1184536179
Provider Name (Legal Business Name): ZACKARY HAMPTON STRANGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE BLDG. 2104
FPO AA
32228
US

IV. Provider business mailing address

1424 LEWIS ST
FERNANDINA BEACH FL
32034-4930
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021551
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: