Provider Demographics
NPI:1427570860
Name:CVJETKOVIC, VEDRANA
Entity Type:Individual
Prefix:
First Name:VEDRANA
Middle Name:
Last Name:CVJETKOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 83RD AVE N APT 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3569
Mailing Address - Country:US
Mailing Address - Phone:727-729-9731
Mailing Address - Fax:
Practice Address - Street 1:727 83RD AVE N APT 203
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3569
Practice Address - Country:US
Practice Address - Phone:727-729-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1288339225100000X
OR62355225100000X
FL30072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist