Provider Demographics
NPI:1639404130
Name:VYAZMENSKY, JENNY N (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:N
Last Name:VYAZMENSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:NARANJO
Other - Last Name:VYAZMENSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18244 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-1945
Mailing Address - Country:US
Mailing Address - Phone:561-487-8825
Mailing Address - Fax:
Practice Address - Street 1:18244 CLEAR BROOK CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-1945
Practice Address - Country:US
Practice Address - Phone:561-487-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist