Provider Demographics
NPI:1255364220
Name:LADYZHENSKY, LEONID (PT)
Entity type:Individual
Prefix:MR
First Name:LEONID
Middle Name:
Last Name:LADYZHENSKY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6088 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4104
Mailing Address - Country:US
Mailing Address - Phone:941-752-0758
Mailing Address - Fax:941-752-4157
Practice Address - Street 1:6088 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4104
Practice Address - Country:US
Practice Address - Phone:941-752-0758
Practice Address - Fax:941-752-4157
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 6466225100000X
NYPT 89862251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8146Medicare ID - Type Unspecified