Provider Demographics
NPI:1518095306
Name:ZOMMER, SAGI (MSPT)
Entity Type:Individual
Prefix:
First Name:SAGI
Middle Name:
Last Name:ZOMMER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LAKE EMERALD DR APT 302
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6276
Mailing Address - Country:US
Mailing Address - Phone:954-484-2182
Mailing Address - Fax:
Practice Address - Street 1:4988 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5748
Practice Address - Country:US
Practice Address - Phone:954-746-7230
Practice Address - Fax:954-746-7350
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist