Provider Demographics
NPI:1205506144
Name:CHERNYSHEVA, NATALIA (LMT)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:CHERNYSHEVA
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 1:15 SW EVERETT MALL WAY STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2715
Mailing Address - Country:US
Mailing Address - Phone:425-355-5222
Mailing Address - Fax:425-355-5231
Practice Address - Street 1:4915 25TH AVE NE STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-8667
Practice Address - Country:US
Practice Address - Phone:206-315-7998
Practice Address - Fax:206-316-2308
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61017211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61017211OtherLICENSE