Provider Demographics
NPI:1427125046
Name:PETROV, GUEORGUI IVANOV (MSPT)
Entity type:Individual
Prefix:MR
First Name:GUEORGUI
Middle Name:IVANOV
Last Name:PETROV
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 1:4205 NW 73RD WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2156
Mailing Address - Country:US
Mailing Address - Phone:954-478-9993
Mailing Address - Fax:
Practice Address - Street 1:2259 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1106
Practice Address - Country:US
Practice Address - Phone:954-725-4160
Practice Address - Fax:954-725-4838
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist