Provider Demographics
NPI:1770381881
Name:SEREDOV, MAKSIM (DPT)
Entity type:Individual
Prefix:
First Name:MAKSIM
Middle Name:
Last Name:SEREDOV
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:SEREDOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:7920 SW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6718
Mailing Address - Country:US
Mailing Address - Phone:818-434-1874
Mailing Address - Fax:
Practice Address - Street 1:5850 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5933
Practice Address - Country:US
Practice Address - Phone:954-289-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL416012251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports