Provider Demographics
NPI:1073959086
Name:BARANOV, ALEXIS (LMP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BARANOV
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 3RD AVE S
Mailing Address - Street 2:APT 210
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-8418
Mailing Address - Country:US
Mailing Address - Phone:206-369-3588
Mailing Address - Fax:
Practice Address - Street 1:424 3RD AVE S
Practice Address - Street 2:APT 210
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-8418
Practice Address - Country:US
Practice Address - Phone:206-369-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60338252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist