Healthcare Provider Details

I. General information

NPI: 1063456804
Provider Name (Legal Business Name): GLORIA B ZAPATA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 37TH AVE STE 602
JACKSON HEIGHTS NY
11372-7015
US

IV. Provider business mailing address

8211 37TH AVE STE 602
JACKSON HEIGHTS NY
11372-7015
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1818
  • Fax: 718-932-3222
Mailing address:
  • Phone: 718-932-1818
  • Fax: 718-932-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024831
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1270021
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: