Provider Demographics
NPI:1013479591
Name:ZAYENCHENKO, ANATOLIY L (LMT)
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:L
Last Name:ZAYENCHENKO
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 1:24 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6359
Mailing Address - Country:US
Mailing Address - Phone:617-223-1941
Mailing Address - Fax:
Practice Address - Street 1:1999 BAY RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-3005
Practice Address - Country:US
Practice Address - Phone:617-851-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA576OtherLICENSE MASSAGE THERAPIST