Provider Demographics
NPI:1326263443
Name:ZACK, SHARON R (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:R
Last Name:ZACK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13939 WELLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9121
Mailing Address - Country:US
Mailing Address - Phone:321-277-7054
Mailing Address - Fax:352-357-7200
Practice Address - Street 1:851 W STATE ROAD 436
Practice Address - Street 2:SUITE 1061
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3000
Practice Address - Country:US
Practice Address - Phone:321-277-7054
Practice Address - Fax:352-357-7200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 43428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist