Provider Demographics
NPI:1568699379
Name:RADZYKEWYCZ, PATRICIA FRANCES (LMP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FRANCES
Last Name:RADZYKEWYCZ
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 1:801 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-1028
Mailing Address - Country:US
Mailing Address - Phone:509-674-2526
Mailing Address - Fax:509-674-2516
Practice Address - Street 1:801 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1028
Practice Address - Country:US
Practice Address - Phone:509-674-2526
Practice Address - Fax:509-674-2516
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60073106225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist