Provider Demographics
NPI:1275123986
Name:ENGEL, ZACHARY (DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:ENGEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 BAYMEADOWS RD E UNIT 1022
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2979
Mailing Address - Country:US
Mailing Address - Phone:615-594-3054
Mailing Address - Fax:
Practice Address - Street 1:465 TOWN PLAZA AVE # B
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5164
Practice Address - Country:US
Practice Address - Phone:904-222-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.10545225100000X
FLPT36612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist