Provider Demographics
NPI:1235601634
Name:AGIL, JOANNE ZEIDAN (PT DPT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ZEIDAN
Last Name:AGIL
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:ZEIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:560 S LAKEWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5015
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-588-6187
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295993225100000X, 2251X0800X
FLPT36957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic