Provider Demographics
NPI:1275919813
Name:GORZHEVSKY, MATVEY (PT)
Entity Type:Individual
Prefix:
First Name:MATVEY
Middle Name:
Last Name:GORZHEVSKY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 NE 207TH ST STE B17
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3705
Mailing Address - Country:US
Mailing Address - Phone:305-306-8376
Mailing Address - Fax:
Practice Address - Street 1:3575 NE 207TH ST STE B17
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3705
Practice Address - Country:US
Practice Address - Phone:305-306-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT305342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic