=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336822527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VLADIMIR MADORSKY PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 08/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10018 SPANISH ISLES BLVD STE A51
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33498-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-672-2103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 673 NE 3RD AVE APT 408
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-672-2103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40509
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------