Provider Demographics
NPI:1245634575
Name:SIDILKOVSKAIA, SVETLANA (DPT)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:SIDILKOVSKAIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 I ST NW
Mailing Address - Street 2:SUITE LL
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20005
Mailing Address - Country:US
Mailing Address - Phone:202-363-1011
Mailing Address - Fax:
Practice Address - Street 1:1444 I ST NW
Practice Address - Street 2:SUITE LL
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-363-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist