Provider Demographics
NPI:1841155629
Name:KOUZNETSOVA, ANGUELINA (LMT)
Entity type:Individual
Prefix:
First Name:ANGUELINA
Middle Name:
Last Name:KOUZNETSOVA
Suffix:
Gender:X
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63152 DESERT SAGE ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63152 DESERT SAGE ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7710
Practice Address - Country:US
Practice Address - Phone:541-390-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-23
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist