Healthcare Provider Details

I. General information

NPI: 1255364220
Provider Name (Legal Business Name): LEONID LADYZHENSKY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6088 14TH ST W
BRADENTON FL
34207-4104
US

IV. Provider business mailing address

6088 14TH ST W
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-0758
  • Fax: 941-752-4157
Mailing address:
  • Phone: 941-752-0758
  • Fax: 941-752-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 6466
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT 8986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: