Provider Demographics
NPI:1265174676
Name:LEZHNYAK, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LEZHNYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 VENETIA BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8038
Mailing Address - Country:US
Mailing Address - Phone:941-202-1195
Mailing Address - Fax:
Practice Address - Street 1:4000 KINGS HWY
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8718
Practice Address - Country:US
Practice Address - Phone:941-255-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist