Provider Demographics
NPI:1275654402
Name:SIZOV, ALEX (LMT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:SIZOV
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 1:22910 E APPLEWAY AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8605
Mailing Address - Country:US
Mailing Address - Phone:509-242-0911
Mailing Address - Fax:509-242-0913
Practice Address - Street 1:22910 E APPLEWAY AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8605
Practice Address - Country:US
Practice Address - Phone:509-242-0911
Practice Address - Fax:509-242-0913
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist