Healthcare Provider Details

I. General information

NPI: 1356688972
Provider Name (Legal Business Name): MARIUSZ W ZMIRSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 GLENFIELDFIELD CROSSING CT
ST AUGUSTINE FL
32092-5035
US

IV. Provider business mailing address

2068 GLENFIELDFIELD CROSSING CT
ST AUGUSTINE FL
32092-5035
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-9992
  • Fax:
Mailing address:
  • Phone: 954-649-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: