Provider Demographics
NPI:1104076777
Name:REZNIKOV, YEFIM (MSPT)
Entity type:Individual
Prefix:
First Name:YEFIM
Middle Name:
Last Name:REZNIKOV
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 REISTERSTOWN ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2720
Mailing Address - Country:US
Mailing Address - Phone:410-363-0004
Mailing Address - Fax:410-902-6971
Practice Address - Street 1:10706 REISTERSTOWN ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2720
Practice Address - Country:US
Practice Address - Phone:410-363-0004
Practice Address - Fax:410-902-6971
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist