Provider Demographics
NPI:1033750112
Name:ISKHAKOV, VLADISLAV (PT, MPT)
Entity Type:Individual
Prefix:
First Name:VLADISLAV
Middle Name:
Last Name:ISKHAKOV
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22007 LINFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1319
Mailing Address - Country:US
Mailing Address - Phone:323-578-8198
Mailing Address - Fax:
Practice Address - Street 1:22007 LINFIELD LN
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1319
Practice Address - Country:US
Practice Address - Phone:323-578-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist