Provider Demographics
NPI:1700245529
Name:VP PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:VP PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEINT
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAKSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-3020
Mailing Address - Street 1:82 VULCAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4221
Mailing Address - Country:US
Mailing Address - Phone:718-998-3020
Mailing Address - Fax:718-998-9059
Practice Address - Street 1:2064 CROPSEY AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6200
Practice Address - Country:US
Practice Address - Phone:718-975-8763
Practice Address - Fax:718-979-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034047OtherLICENSE