Provider Demographics
NPI:1235772591
Name:KRUGHKOV, ZHANNA (MT)
Entity Type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:KRUGHKOV
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NE 109TH CT STE L
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6174
Mailing Address - Country:US
Mailing Address - Phone:360-773-7262
Mailing Address - Fax:
Practice Address - Street 1:5501 NE 109TH CT STE L
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6174
Practice Address - Country:US
Practice Address - Phone:360-773-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60998876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist