MEDICARE: DR. ALEX SIYUFY 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
1	225100000X	Physical Therapist	2305203959	VA
2	2255A2300X	Athletic Trainer	0126000740	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497742795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX SIYUFY PT

Provider Business Mailing Address
First Line	:	P.O.BOX 5982
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23471-0982
Country	:	US
Telephone Number	:	757-228-5201
Fax Number	:	757-481-6175

Provider Business Practice Location Address
First Line	:	762 INDEPENDENCE BLVD STE 772
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6200
Country	:	US
Telephone Number	:	757-228-5201
Fax Number	:	757-481-6175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2005
Last Update Date	:	03/10/2011

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Directions to “ DR. ALEX SIYUFY PT” Practice Location

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