Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160505759 | WA |
NPI | 1003280322 |
---|---|
Provider Name | Dmitriy Andrushchenko |
First Address | Federal Way, WA 98023-7711 |
Second Address | Federal Way, WA 98023-7711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2015 |
Last Update Date | 24/11/2015 |