Provider Demographics
NPI:1669473930
Name:ZAYAS, MANUEL RAGANDANG (PT)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:RAGANDANG
Last Name:ZAYAS
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 1:17820 SE 109TH AVE
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-693-2152
Mailing Address - Fax:352-693-2154
Practice Address - Street 1:17820 SE 109TH AVE
Practice Address - Street 2:SUITE 105B
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-693-2152
Practice Address - Fax:352-693-2154
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist