Provider Demographics
NPI:1497208821
Name:ZERN, VICTORIA (PTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ZERN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:STIRBU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:6103 DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6743
Mailing Address - Country:US
Mailing Address - Phone:386-631-4904
Mailing Address - Fax:
Practice Address - Street 1:911 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2560
Practice Address - Country:US
Practice Address - Phone:386-736-3108
Practice Address - Fax:386-736-3643
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58257225700000X
FLPTA26766225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist