MEDICARE: MATTHEW ZERAH PT, DPT, ATC

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	PT33608	FL

General Provider Information

NPI Number	:	1700379575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ZERAH PT, DPT, ATC

Provider Business Mailing Address
First Line	:	21756 STATE ROAD 54
Second Line	:	STE 102
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 CORDOVA RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2157
Country	:	US
Telephone Number	:	954-909-0899
Fax Number	:

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

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	01/06/2021

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