Provider Demographics
NPI:1104317395
Name:WANG, ZHIXIN (PT)
Entity type:Individual
Prefix:
First Name:ZHIXIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 W WATERS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2875
Mailing Address - Country:US
Mailing Address - Phone:813-454-5715
Mailing Address - Fax:813-558-6186
Practice Address - Street 1:3102 W WATERS AVE STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2875
Practice Address - Country:US
Practice Address - Phone:813-454-5715
Practice Address - Fax:813-558-6186
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33559225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist