Healthcare Provider Details

I. General information

NPI: 1356572531
Provider Name (Legal Business Name): NAVAH ZIZMOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HARVARD AVE
STAMFORD CT
06902-5506
US

IV. Provider business mailing address

3530 POST RD
SOUTHPORT CT
06890-1169
US

V. Phone/Fax

Practice location:
  • Phone: 203-307-4600
  • Fax: 203-307-4601
Mailing address:
  • Phone: 203-307-4600
  • Fax: 203-307-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031664-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010341
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: