Healthcare Provider Details

I. General information

NPI: 1518066471
Provider Name (Legal Business Name): DAVID MARC ESACK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 N SOUTHLAKE DR
HOLLYWOOD FL
33019-1523
US

IV. Provider business mailing address

1130 N SOUTHLAKE DR
HOLLYWOOD FL
33019-1523
US

V. Phone/Fax

Practice location:
  • Phone: 954-929-5032
  • Fax: 954-925-4637
Mailing address:
  • Phone: 954-929-5032
  • Fax: 954-925-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: