Provider Demographics
NPI:1487666988
Name:AVAKOV, SERGUEI (PT)
Entity Type:Individual
Prefix:
First Name:SERGUEI
Middle Name:
Last Name:AVAKOV
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 1:808 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2436
Mailing Address - Country:US
Mailing Address - Phone:215-579-6269
Mailing Address - Fax:215-953-9943
Practice Address - Street 1:2 PARK LN
Practice Address - Street 2:SUITE 104
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6004
Practice Address - Country:US
Practice Address - Phone:215-953-9944
Practice Address - Fax:215-953-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist