Provider Demographics
NPI:1841987864
Name:YEVSUKOV, VERONICA MARIE
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:MARIE
Last Name:YEVSUKOV
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 1:1324 BELMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4543
Mailing Address - Country:US
Mailing Address - Phone:410-656-9953
Mailing Address - Fax:
Practice Address - Street 1:1324 BELMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4543
Practice Address - Country:US
Practice Address - Phone:410-656-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist