Provider Demographics
NPI:1083493068
Name:DYACHENKO, LYUDMILA (LMT)
Entity Type:Individual
Prefix:MS
First Name:LYUDMILA
Middle Name:
Last Name:DYACHENKO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6601
Mailing Address - Country:US
Mailing Address - Phone:215-914-0469
Mailing Address - Fax:
Practice Address - Street 1:2415 MICHAEL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6601
Practice Address - Country:US
Practice Address - Phone:215-914-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist