Provider Demographics
NPI:1942609185
Name:BYZEWSKI, ELENA V (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:V
Last Name:BYZEWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-373-2919
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:1745 CAMELOT DR STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2435
Practice Address - Country:US
Practice Address - Phone:757-961-4800
Practice Address - Fax:757-961-0233
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942609185OtherMEDICAID QMB
VAC05954OtherGROUP MEDICARE PTAN
VAQ47680AMedicare PIN