Provider Demographics
NPI:1720624257
Name:LUTSKOV, YULIYA (MA60040556)
Entity Type:Individual
Prefix:MRS
First Name:YULIYA
Middle Name:
Last Name:LUTSKOV
Suffix:
Gender:F
Credentials:MA60040556
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 EVERGREEN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5683
Mailing Address - Country:US
Mailing Address - Phone:425-382-2188
Mailing Address - Fax:888-741-1274
Practice Address - Street 1:7404 EVERGREEN WAY STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5683
Practice Address - Country:US
Practice Address - Phone:425-382-2188
Practice Address - Fax:888-741-1274
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60040556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710037874OtherCHIROPRACTIC