MEDICARE: ZESS MISTY ILAN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT40842	FL

General Provider Information

NPI Number	:	1245982826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZESS MISTY ILAN PT, DPT

Provider Business Mailing Address
First Line	:	6917 REED GRASS PLACE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746
Country	:	US
Telephone Number	:	224-801-9190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SOUTHGATE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6593
Country	:	US
Telephone Number	:	407-933-1325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	04/27/2024

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