Provider Demographics
NPI:1841672938
Name:BUSEV, YURIY (LMP)
Entity type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:BUSEV
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 1:11122 15TH PL SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7937
Mailing Address - Country:US
Mailing Address - Phone:425-501-5116
Mailing Address - Fax:
Practice Address - Street 1:11611 AIRPORT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3782
Practice Address - Country:US
Practice Address - Phone:425-322-5307
Practice Address - Fax:425-322-5241
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60529309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist