Healthcare Provider Details

I. General information

NPI: 1043825904
Provider Name (Legal Business Name): BEATA ZOLADZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BAYVIEW DR APT 222
SUNNY ISLES BEACH FL
33160-4748
US

IV. Provider business mailing address

500 BAYVIEW DR APT 222
SUNNY ISLES BEACH FL
33160-4748
US

V. Phone/Fax

Practice location:
  • Phone: 239-822-0691
  • Fax:
Mailing address:
  • Phone: 239-822-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA92815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: