Provider Demographics
NPI:1194421768
Name:ZAGROCKI, ANDREW PAUL (LMT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PAUL
Last Name:ZAGROCKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WATERMILL PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7645
Mailing Address - Country:US
Mailing Address - Phone:321-231-4666
Mailing Address - Fax:
Practice Address - Street 1:4869 PALM COAST PKWY NW UNIT 3
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3667
Practice Address - Country:US
Practice Address - Phone:321-231-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101128225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty