Provider Demographics
NPI:1821501263
Name:STETSYUK, OLEKSANDR (LMT)
Entity Type:Individual
Prefix:MR
First Name:OLEKSANDR
Middle Name:
Last Name:STETSYUK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 227TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8006
Mailing Address - Country:US
Mailing Address - Phone:425-287-3691
Mailing Address - Fax:
Practice Address - Street 1:18530 156TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8409
Practice Address - Country:US
Practice Address - Phone:425-287-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60791969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty