Healthcare Provider Details

I. General information

NPI: 1306323670
Provider Name (Legal Business Name): ZACHARY SYKES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 CHENEY HWY
TITUSVILLE FL
32780-6959
US

IV. Provider business mailing address

6260 JANINA RD
COCOA FL
32927-8566
US

V. Phone/Fax

Practice location:
  • Phone: 321-269-8155
  • Fax:
Mailing address:
  • Phone: 407-399-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: