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General NPI Number Information
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NPI Number | 1316658263
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Entity Type | Individual
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Provider Name | SHMUEL ZEV ZIDELL DPT
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Gender | Male
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 21895 LAKE FOREST CIR APT 204
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City | BOCA RATON
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State | FL
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Zip | 33433-3318
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Country | US
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Telephone | 305-505-2565
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Fax | 305-675-3363
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Provider Business Mailing Address
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Address Line | 4575 N MICHIGAN AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2918
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Country | US
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Telephone | 305-505-2565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 39542
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License Number State | FL
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