Provider Demographics
NPI:1407418635
Name:VLADIMIR FEDOSSEEV PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:VLADIMIR FEDOSSEEV PHYSICAL THERAPY PC
Other - Org Name:VF PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDOSSEEV
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:718-808-9337
Mailing Address - Street 1:3371 RICHMOND AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2025
Mailing Address - Country:US
Mailing Address - Phone:718-808-9337
Mailing Address - Fax:347-983-6126
Practice Address - Street 1:3371 RICHMOND AVE
Practice Address - Street 2:LOWER LEVEL STE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2025
Practice Address - Country:US
Practice Address - Phone:718-808-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty