Provider Demographics
NPI:1902939937
Name:GRUEV, TZVETANKA (PT)
Entity Type:Individual
Prefix:
First Name:TZVETANKA
Middle Name:
Last Name:GRUEV
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3634
Mailing Address - Country:US
Mailing Address - Phone:954-989-5255
Mailing Address - Fax:954-962-6445
Practice Address - Street 1:3850 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3634
Practice Address - Country:US
Practice Address - Phone:954-989-5255
Practice Address - Fax:954-962-6445
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY914ROtherBLUE CROSS BLUE SHIELD
FL372531000OtherDEPT. OF LABOR
FL372531000OtherDEPT. OF LABOR