Provider Demographics
NPI:1568975779
Name:DATSKIY, ANDREY AMOSOVICH (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:AMOSOVICH
Last Name:DATSKIY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 ALDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1223
Mailing Address - Country:US
Mailing Address - Phone:360-733-2322
Mailing Address - Fax:
Practice Address - Street 1:2726 ALDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1223
Practice Address - Country:US
Practice Address - Phone:360-733-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160043563225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant