Provider Demographics
NPI:1518066471
Name:ESACK, DAVID MARC (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARC
Last Name:ESACK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N SOUTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1523
Mailing Address - Country:US
Mailing Address - Phone:954-929-5032
Mailing Address - Fax:954-925-4637
Practice Address - Street 1:1130 N SOUTHLAKE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1523
Practice Address - Country:US
Practice Address - Phone:954-929-5032
Practice Address - Fax:954-925-4637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist