Provider Demographics
NPI:1275215451
Name:BULUCHEVSKAYA, YELIZAVETA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:
Last Name:BULUCHEVSKAYA
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 S UNIVERSITY DR APT 2104
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5354
Mailing Address - Country:US
Mailing Address - Phone:214-284-4373
Mailing Address - Fax:
Practice Address - Street 1:3313 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3606
Practice Address - Country:US
Practice Address - Phone:754-202-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist