Healthcare Provider Details

I. General information

NPI: 1003745787
Provider Name (Legal Business Name): ZACHARY FORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11754 E MLK BLVD
SEFFNER FL
33584-4923
US

IV. Provider business mailing address

18217 HAWTHORNE RD
FORT MYERS FL
33967-5227
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-8267
  • Fax:
Mailing address:
  • Phone: 239-250-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: