Provider Demographics
NPI:1659447639
Name:RYBAK, JUDY A (LMP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:RYBAK
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 1:8050 MUKILTEO SPEEDWAY
Mailing Address - Street 2:#433
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-0433
Mailing Address - Country:US
Mailing Address - Phone:425-772-0807
Mailing Address - Fax:425-348-3040
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-771-2966
Practice Address - Fax:425-348-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist