Healthcare Provider Details

I. General information

NPI: 1528105244
Provider Name (Legal Business Name): ROBERT ZICCHINO MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6383
US

IV. Provider business mailing address

24240 SUMMER WIND CT
LUTZ FL
33559-7926
US

V. Phone/Fax

Practice location:
  • Phone: 813-348-9688
  • Fax: 813-348-9687
Mailing address:
  • Phone: 813-909-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: