Provider Demographics
NPI:1699300681
Name:ZACHAR, ALEC
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:ZACHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35419 POINSETTIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-2005
Mailing Address - Country:US
Mailing Address - Phone:352-360-8438
Mailing Address - Fax:
Practice Address - Street 1:35419 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-2005
Practice Address - Country:US
Practice Address - Phone:352-360-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29998225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant