Healthcare Provider Details

I. General information

NPI: 1255754792
Provider Name (Legal Business Name): YEVGENIY SYCHEV PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 VIRGINIA AVE
HARRISONBURG VA
22802-2433
US

IV. Provider business mailing address

2425 MILLWOOD LOOP
HARRISONBURG VA
22801-4562
US

V. Phone/Fax

Practice location:
  • Phone: 540-438-4228
  • Fax:
Mailing address:
  • Phone: 540-435-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: