Provider Demographics
NPI:1073918801
Name:BLUDEVICH, ZAFIR GEORGE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ZAFIR
Middle Name:GEORGE
Last Name:BLUDEVICH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7061
Mailing Address - Country:US
Mailing Address - Phone:802-878-6700
Mailing Address - Fax:
Practice Address - Street 1:115 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2088
Practice Address - Country:US
Practice Address - Phone:802-860-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0002582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist