Provider Demographics
NPI:1841887007
Name:KRAVCHENKO, YELENA (PTA)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KRAVCHENKO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WAYNE COURT SE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047
Mailing Address - Country:US
Mailing Address - Phone:425-563-4460
Mailing Address - Fax:
Practice Address - Street 1:511 WAYNE COURT SE
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:WA
Practice Address - Zip Code:98047
Practice Address - Country:US
Practice Address - Phone:425-563-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160827701225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant