Provider Demographics
NPI:1629603931
Name:BERES, ZOE (LICENSED MASSA THERA)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:BERES
Suffix:
Gender:F
Credentials:LICENSED MASSA THERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SE 23RD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1442
Mailing Address - Country:US
Mailing Address - Phone:239-565-8792
Mailing Address - Fax:
Practice Address - Street 1:325 SE 23RD AVE APT 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1442
Practice Address - Country:US
Practice Address - Phone:239-565-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist