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General NPI Number Information
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NPI Number | 1609387737
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Entity Type | Individual
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Provider Name | VASIL DIMITROV DIMITROV PT
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Gender | Male
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 2311 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1007
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Country | US
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Telephone | 215-331-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 10905 NANDINA CT FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3109
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Country | US
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Telephone | 773-675-0523
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT026119
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License Number State | PA
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