MEDICARE: SHMUEL ZEV ZIDELL 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	39542	FL

General Provider Information

NPI Number	:	1316658263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHMUEL ZEV ZIDELL DPT

Provider Business Mailing Address
First Line	:	4575 N MICHIGAN AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2918
Country	:	US
Telephone Number	:	305-505-2565
Fax Number	:

Provider Business Practice Location Address
First Line	:	21895 LAKE FOREST CIR APT 204
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3318
Country	:	US
Telephone Number	:	305-505-2565
Fax Number	:	305-675-3363

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/16/2024

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