Provider Demographics
NPI:1104273846
Name:ZICCARDI, VANESSA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:ZICCARDI
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 1:5400 S UNIVERSITY DR STE 302
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5310
Mailing Address - Country:US
Mailing Address - Phone:754-206-3772
Mailing Address - Fax:754-206-3802
Practice Address - Street 1:5400 S UNIVERSITY DR STE 302
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5310
Practice Address - Country:US
Practice Address - Phone:754-206-3772
Practice Address - Fax:754-206-3802
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist