Provider Demographics
NPI:1437200250
Name:FYODOROVA, ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FYODOROVA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 QUENTIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2251
Mailing Address - Country:US
Mailing Address - Phone:718-998-9890
Mailing Address - Fax:718-998-9891
Practice Address - Street 1:813 QUENTIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2251
Practice Address - Country:US
Practice Address - Phone:718-998-9890
Practice Address - Fax:718-998-9891
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028955-1OtherSTATE LICENSE