Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE009026 | PA |
NPI | 1003193103 |
---|---|
Provider Name | Vadim Sychuk |
First Address | Erie, PA 16506-3376 |
Second Address | Girard, PA 16417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2011 |
Last Update Date | 03/11/2011 |