MEDICARE: JULIAN EZEKIEL VESNOVSKY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	26971	MD

General Provider Information

NPI Number	:	1528559267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN EZEKIEL VESNOVSKY DPT

Provider Business Mailing Address
First Line	:	1600 CRAIN HWY S
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5577
Country	:	US
Telephone Number	:	410-590-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CRAIN HWY S STE 402
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-6437
Country	:	US
Telephone Number	:	410-590-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	09/29/2020

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