Provider Demographics
NPI:1710592456
Name:VERETILNYK, LIUDMYLA (CMT)
Entity Type:Individual
Prefix:MRS
First Name:LIUDMYLA
Middle Name:
Last Name:VERETILNYK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MRS
Other - First Name:LIUDMYLA
Other - Middle Name:
Other - Last Name:MCKAMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:5248 LOCKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2750
Mailing Address - Country:US
Mailing Address - Phone:707-508-7988
Mailing Address - Fax:
Practice Address - Street 1:838 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4538
Practice Address - Country:US
Practice Address - Phone:707-508-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist