Provider Demographics
NPI:1740743004
Name:KUSMIY-SANDERS, NATALYA (LMT)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:KUSMIY-SANDERS
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 1:593 SOUTH MCDONALD RD SW
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5412
Mailing Address - Country:US
Mailing Address - Phone:866-427-8427
Mailing Address - Fax:
Practice Address - Street 1:593 S MCDONALD RD SW
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:TN
Practice Address - Zip Code:37353-5412
Practice Address - Country:US
Practice Address - Phone:423-645-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012630225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist