Provider Demographics
NPI:1588441075
Name:HAACK, ZOFIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ZOFIA
Middle Name:
Last Name:HAACK
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 1:635 CENTURY PT STE 111
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2139
Mailing Address - Country:US
Mailing Address - Phone:954-235-8312
Mailing Address - Fax:
Practice Address - Street 1:635 CENTURY PT STE 111
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2139
Practice Address - Country:US
Practice Address - Phone:407-792-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist