Provider Demographics
NPI:1801138169
Name:SCHUKAR-KOLPAKOVA, EKATERINA VICTORIA (LMT)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:VICTORIA
Last Name:SCHUKAR-KOLPAKOVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EKATERINA
Other - Middle Name:VICTORIA
Other - Last Name:SCHUKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:6785 E WESWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9642
Mailing Address - Country:US
Mailing Address - Phone:402-450-4353
Mailing Address - Fax:
Practice Address - Street 1:4900 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7752
Practice Address - Country:US
Practice Address - Phone:402-450-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1732225700000X
AK107364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist