Healthcare Provider Details

I. General information

NPI: 1710985833
Provider Name (Legal Business Name): MICHAEL J. ZOGHBY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 GREENO ROAD
FAIRHOPE AL
36532
US

IV. Provider business mailing address

PO BOX 1186
FAIRHOPE AL
36533-1186
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2401
  • Fax: 251-928-5099
Mailing address:
  • Phone: 251-928-2401
  • Fax: 251-928-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTH500
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: