Healthcare Provider Details

I. General information

NPI: 1043435266
Provider Name (Legal Business Name): CHRISTIAN J PACHECO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 S JOG RD STE 100
DELRAY BEACH FL
33446-3808
US

IV. Provider business mailing address

2809 NE 3RD TERRACE
WILTON MANORS FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5144
  • Fax:
Mailing address:
  • Phone: 954-562-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2700
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: