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General NPI Number Information
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NPI Number | 1275215451
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Entity Type | Individual
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Provider Name | YELIZAVETA BULUCHEVSKAYA PT, DPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 3313 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3606
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Country | US
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Telephone | 754-202-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 5520 S UNIVERSITY DR APT 2104
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City | DAVIE
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State | FL
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Zip | 33328-5354
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Country | US
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Telephone | 214-284-4373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40243
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License Number State | FL
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