Provider Demographics
NPI:1336822527
Name:MADORSKY, VLADIMIR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:MADORSKY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 NE 3RD AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2744
Mailing Address - Country:US
Mailing Address - Phone:352-672-2103
Mailing Address - Fax:
Practice Address - Street 1:10018 SPANISH ISLES BLVD STE A51
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6324
Practice Address - Country:US
Practice Address - Phone:352-672-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist