Provider Demographics
NPI:1669688131
Name:JOURAVLEV, YURI V (LMP)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:V
Last Name:JOURAVLEV
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8752 NE 144TH CT
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5011
Mailing Address - Country:US
Mailing Address - Phone:425-821-8524
Mailing Address - Fax:425-821-8524
Practice Address - Street 1:8752 NE 144TH CT
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5011
Practice Address - Country:US
Practice Address - Phone:425-821-8524
Practice Address - Fax:425-821-8524
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist