Provider Demographics
NPI:1568972925
Name:BRONCHTAIN, TZIRIL (PT)
Entity Type:Individual
Prefix:
First Name:TZIRIL
Middle Name:
Last Name:BRONCHTAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 LAGO DEL MAR DR APT 10
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4982
Mailing Address - Country:US
Mailing Address - Phone:646-703-3795
Mailing Address - Fax:
Practice Address - Street 1:8276 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3715
Practice Address - Country:US
Practice Address - Phone:646-703-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041868225100000X
FL35200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104983000Medicaid