Provider Demographics
NPI:1013354216
Name:VOZNYUK, ALEKSANDR (PTA)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:VOZNYUK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 FOUNTAIN LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-2454
Mailing Address - Country:US
Mailing Address - Phone:612-222-5868
Mailing Address - Fax:
Practice Address - Street 1:5021 FOUNTAIN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2454
Practice Address - Country:US
Practice Address - Phone:763-245-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1449225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA1449OtherMN BOARD OF PT