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Organization

BAYSHORE REHABILITATION, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LEONID LADYZHENSKY P.T. (PRESIDENT)
(941) 752-0758
Entity
Organization

Contact information

Practice address
6088 14TH ST W, BRADENTON, FL 34207-4104
(941) 752-0758
(941) 752-4157
Mailing address
6088 14TH ST W, BRADENTON, FL 34207-4104
(941) 752-0758
(941) 752-4157

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT6466
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
Y8146
PTAN
FL
Enumeration date
10/14/2010
Last updated
10/14/2010
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