=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568628113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALENTYNA NESTEROVA PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 07/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 S CONGRESS AVENUE
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-4746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-701-1287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12538 NW 57TH CT
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33076-3469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-701-1287
-----------------------------------------------------
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 | 23567
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------