Provider Demographics
NPI:1457701658
Name:AMPLYEYEV, VLADIMIR
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:AMPLYEYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 W 2ND AVE
Mailing Address - Street 2:APT 303
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5828
Mailing Address - Country:US
Mailing Address - Phone:509-638-3000
Mailing Address - Fax:
Practice Address - Street 1:2321 W 2ND AVE
Practice Address - Street 2:APT 303
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5828
Practice Address - Country:US
Practice Address - Phone:509-638-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist