Healthcare Provider Details

I. General information

NPI: 1306911946
Provider Name (Legal Business Name): JUDITH TZOUCALIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W CAMINO REAL 101
BOCA RATON FL
33433-5511
US

IV. Provider business mailing address

7200 W CAMINO REAL 101
BOCA RATON FL
33433-5511
US

V. Phone/Fax

Practice location:
  • Phone: 561-417-9563
  • Fax: 561-417-9564
Mailing address:
  • Phone: 561-417-9563
  • Fax: 561-417-9564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: