Provider Demographics
NPI:1093359879
Name:DEVIRGILIO, ZACHARY (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:DEVIRGILIO
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 B ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6811
Mailing Address - Country:US
Mailing Address - Phone:772-713-8350
Mailing Address - Fax:
Practice Address - Street 1:111 B ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6811
Practice Address - Country:US
Practice Address - Phone:772-713-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist