Provider Demographics
NPI:1346831427
Name:HEISER, ZACHARY CHAD
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:CHAD
Last Name:HEISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9455 KOGER BLVD N STE 113
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2431
Mailing Address - Country:US
Mailing Address - Phone:727-200-1319
Mailing Address - Fax:
Practice Address - Street 1:9455 KOGER BLVD N STE 113
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2431
Practice Address - Country:US
Practice Address - Phone:727-200-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist