Provider Demographics
NPI:1689250565
Name:IANUSHKEVYCH, TETIANA (LMT)
Entity Type:Individual
Prefix:
First Name:TETIANA
Middle Name:
Last Name:IANUSHKEVYCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 25TH AVE NE UNIT 304
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-2609
Mailing Address - Country:US
Mailing Address - Phone:425-426-9486
Mailing Address - Fax:
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-868-9593
Practice Address - Fax:425-868-6826
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist