Provider Demographics
NPI:1972843605
Name:KAGRAMANOV, BORYS B (LMP)
Entity Type:Individual
Prefix:
First Name:BORYS
Middle Name:B
Last Name:KAGRAMANOV
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19201 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7379
Mailing Address - Country:US
Mailing Address - Phone:253-859-6441
Mailing Address - Fax:253-859-9437
Practice Address - Street 1:19201 108TH AVE SE
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:253-859-6441
Practice Address - Fax:253-859-9437
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60288002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist