Provider Demographics
NPI:1073746400
Name:V.I.P.PHYSICAL THERAPY
Entity Type:Organization
Organization Name:V.I.P.PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-732-6005
Mailing Address - Street 1:130 MAPLE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2215
Mailing Address - Country:US
Mailing Address - Phone:413-732-6005
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE ST STE 310
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2215
Practice Address - Country:US
Practice Address - Phone:413-732-6005
Practice Address - Fax:413-732-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty