Provider Demographics
NPI:1821373572
Name:LYEBYEDYEV, LILIYA
Entity Type:Individual
Prefix:
First Name:LILIYA
Middle Name:
Last Name:LYEBYEDYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26024 162ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8275
Mailing Address - Country:US
Mailing Address - Phone:206-235-6545
Mailing Address - Fax:
Practice Address - Street 1:19201 108TH AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7379
Practice Address - Country:US
Practice Address - Phone:206-235-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60065263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist