Provider Demographics
NPI:1225160625
Name:FRADKINA, EMILIYA I (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:EMILIYA
Middle Name:I
Last Name:FRADKINA
Suffix:
Gender:F
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 1:13050 WEATHERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3646
Mailing Address - Country:US
Mailing Address - Phone:314-317-9881
Mailing Address - Fax:
Practice Address - Street 1:13050 WEATHERFIELD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3646
Practice Address - Country:US
Practice Address - Phone:314-317-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist