Provider Demographics
NPI:1720158330
Name:BRODSKY, VADIM
Entity type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3412
Mailing Address - Country:US
Mailing Address - Phone:215-635-5575
Mailing Address - Fax:
Practice Address - Street 1:8118 OLD YORK ROAD, UL SUITE E
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1423
Practice Address - Country:US
Practice Address - Phone:215-635-5575
Practice Address - Fax:215-635-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16987222Q00000X
PAPT015515222Q00000X, 2251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078730Medicare PIN