Healthcare Provider Details

I. General information

NPI: 1316770241
Provider Name (Legal Business Name): DANIEL ZHUKOVSKIY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 LAKE WORTH RD STE 500
LAKE WORTH FL
33467-2516
US

IV. Provider business mailing address

7408 LAKE WORTH RD STE 500
LAKE WORTH FL
33467-2516
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-3693
  • Fax: 561-432-3694
Mailing address:
  • Phone: 561-432-3693
  • Fax: 561-432-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: