Provider Demographics
NPI:1649975590
Name:VOLKOVA, ANNA A (LAC, PTA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:A
Last Name:VOLKOVA
Suffix:
Gender:F
Credentials:LAC, PTA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:A
Other - Last Name:TATARINOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1221
Mailing Address - Country:US
Mailing Address - Phone:347-506-9061
Mailing Address - Fax:
Practice Address - Street 1:40 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1221
Practice Address - Country:US
Practice Address - Phone:347-506-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00350400225200000X
NJ25MZ00164200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant