Provider Demographics
NPI:1841509940
Name:POLYAKOV, DIMITRY (DPT)
Entity type:Individual
Prefix:MR
First Name:DIMITRY
Middle Name:
Last Name:POLYAKOV
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WATCHUNG AVE
Mailing Address - Street 2:TOTAL PHYSICAL THERAPY
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07928
Mailing Address - Country:US
Mailing Address - Phone:908-268-1913
Mailing Address - Fax:973-701-1616
Practice Address - Street 1:13 WATCHUNG AVE
Practice Address - Street 2:TOTAL PHYSICAL THERAPY
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928
Practice Address - Country:US
Practice Address - Phone:908-268-1913
Practice Address - Fax:973-701-1616
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00635300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist