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NPI Code Detail

MEDICARE: VADIM AYZENSHTAT PT

MEDICARE: VADIM AYZENSHTAT PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPENDINGAZ

General Provider Information

NPI Number : 1366104192
Entity Type Code : Individual
Provider Name (Legal Business Name) : VADIM AYZENSHTAT PT
Provider Business Mailing Address
First Line : PO BOX 31630
Second Line :
City : TUCSON
State : AZ
Zip : 85751-1630
Country : US
Telephone Number : 520-784-6570
Fax Number : 520-784-6575
Provider Business Practice Location Address
First Line : 2424 N WYATT DR STE 130
Second Line :
City : TUCSON
State : AZ
Zip : 85712-6102
Country : US
Telephone Number : 520-784-6570
Fax Number : 520-784-6575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2021
Last Update Date : 03/28/2022

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Directions to “ VADIM AYZENSHTAT PT” Practice Location

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