=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821942004
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUSLAN DZHORGOV
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2629 DEL PRADO BLVD S
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-5769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-574-4434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2223 GRACE AVE
-----------------------------------------------------
City | FORT MITCHELL
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-574-4434
-----------------------------------------------------
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 | PT44337
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------