Provider Demographics
NPI:1508502352
Name:WRONIUK-EVANS, ZACKERY (DPT)
Entity Type:Individual
Prefix:DR
First Name:ZACKERY
Middle Name:
Last Name:WRONIUK-EVANS
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 1:9960 ESTERO OAKS DR APT 213
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5311
Mailing Address - Country:US
Mailing Address - Phone:856-776-1039
Mailing Address - Fax:
Practice Address - Street 1:9960 ESTERO OAKS DR APT 213
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5311
Practice Address - Country:US
Practice Address - Phone:856-776-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist