Healthcare Provider Details

I. General information

NPI: 1851523807
Provider Name (Legal Business Name): DENNIS SHCHERBAKOV PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MENTOR AVE
PAINESVILLE OH
44077-3105
US

IV. Provider business mailing address

263 MENTOR AVE
PAINESVILLE OH
44077-3105
US

V. Phone/Fax

Practice location:
  • Phone: 440-354-5643
  • Fax: 440-354-5645
Mailing address:
  • Phone: 440-354-5643
  • Fax: 440-354-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: