Provider Demographics
NPI:1083809073
Name:ZYDERVELD, JEANNETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:ZYDERVELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SLIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3901
Mailing Address - Country:US
Mailing Address - Phone:407-649-6888
Mailing Address - Fax:407-246-0135
Practice Address - Street 1:1301 SLIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3901
Practice Address - Country:US
Practice Address - Phone:407-649-6888
Practice Address - Fax:407-246-0135
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000698600Medicaid