MEDICARE: VADIM BRODSKY

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	222Q00000X	Developmental Therapist	PT16987	FL
2	222Q00000X	Developmental Therapist	PT015515	PA
3	2251G0304X	Geriatric Physical Therapist	PT015515	PA
4	225100000X	Physical Therapist	PT015515	PA

General Provider Information

NPI Number	:	1720158330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VADIM BRODSKY

Provider Business Mailing Address
First Line	:	3538 ORIOLE DR
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3412
Country	:	US
Telephone Number	:	215-635-5575
Fax Number	:

Provider Business Practice Location Address
First Line	:	8118 OLD YORK ROAD, UL SUITE E
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1423
Country	:	US
Telephone Number	:	215-635-5575
Fax Number	:	215-635-5456

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/21/2022

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Directions to “ VADIM BRODSKY ” Practice Location

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