Healthcare Provider Details

I. General information

NPI: 1396182598
Provider Name (Legal Business Name): LOUIZARAH ZOSA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16089 POPPYSEED CIR SUITE 2008
DELRAY BEACH FL
33484-6314
US

IV. Provider business mailing address

16089 POPPYSEED CIR SUITE 2008
DELRAY BEACH FL
33484-6314
US

V. Phone/Fax

Practice location:
  • Phone: 561-271-4215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.019783
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29043
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011074A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: