Provider Demographics
NPI:1770781049
Name:ZRAZHEVSKI, SERGEY V (LMP)
Entity type:Individual
Prefix:MR
First Name:SERGEY
Middle Name:V
Last Name:ZRAZHEVSKI
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:SUITE B50
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-825-0898
Mailing Address - Fax:425-823-6348
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE B50
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-825-0898
Practice Address - Fax:425-823-6348
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist