Provider Demographics
NPI:1215716170
Name:VERGULYANETS, DAVID PAVLOVICH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAVLOVICH
Last Name:VERGULYANETS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SE CHKALOV DR STE 3 #199
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:503-208-4130
Mailing Address - Fax:503-961-1228
Practice Address - Street 1:109 SE 101ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3907
Practice Address - Country:US
Practice Address - Phone:503-208-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist