Provider Demographics
NPI:1598249534
Name:ZAMORANO, JAIRO (PTA)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:ZAMORANO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 NE 171ST ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3060
Mailing Address - Country:US
Mailing Address - Phone:954-494-8257
Mailing Address - Fax:
Practice Address - Street 1:2599 NW 55TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2443
Practice Address - Country:US
Practice Address - Phone:954-485-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA16936225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant