Provider Demographics
NPI:1952418972
Name:NAROSOV, SEMYON (MSPT)
Entity Type:Individual
Prefix:
First Name:SEMYON
Middle Name:
Last Name:NAROSOV
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781667
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75378-1667
Mailing Address - Country:US
Mailing Address - Phone:214-352-3000
Mailing Address - Fax:214-358-2418
Practice Address - Street 1:2351 W NORTHWEST HWY
Practice Address - Street 2:STE 3100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:214-352-3000
Practice Address - Fax:214-358-2418
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4657OtherBLUE CROSS BLUE SHIELD
TX8E0540Medicare ID - Type Unspecified