Provider Demographics
NPI:1497742795
Name:SIYUFY, ALEX (PT)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:SIYUFY
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:P.O.BOX 5982
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0982
Mailing Address - Country:US
Mailing Address - Phone:757-228-5201
Mailing Address - Fax:757-481-6175
Practice Address - Street 1:762 INDEPENDENCE BLVD STE 772
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6200
Practice Address - Country:US
Practice Address - Phone:757-228-5201
Practice Address - Fax:757-481-6175
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203959225100000X
VA01260007402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010339201Medicaid
VA010339219Medicaid
VA010337909Medicaid
VA010337917Medicaid
VA010338239Medicaid
VA010339227Medicaid
VA010339201Medicaid