Provider Demographics
NPI:1245982826
Name:ILAN, ZESS MISTY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ZESS MISTY
Middle Name:
Last Name:ILAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 REED GRASS PLACE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746
Mailing Address - Country:US
Mailing Address - Phone:224-801-9190
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6593
Practice Address - Country:US
Practice Address - Phone:407-933-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist