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General NPI Number Information
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NPI Number | 1770749236
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Entity Type | Individual
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Provider Name | ZACHARY ROBERT CONSTANCE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/30/2008
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Provider Practice Location Address
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Address Line | 250 INTERNATIONAL PKWY SUITE 260
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City | LAKE MARY
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State | FL
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Zip | 32746-5030
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Country | US
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Telephone | 407-833-8815
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Fax | 407-833-9177
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Provider Business Mailing Address
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Address Line | 250 INTERNATIONAL PKWY SUITE 260
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City | LAKE MARY
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State | FL
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Zip | 32746-5030
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Country | US
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Telephone | 407-833-8815
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Fax | 407-833-9177
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11-03818
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License Number State | KS
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