Provider Demographics
NPI:1124165329
Name:KORYACHEK, ALEXANDER V (LMT)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:V
Last Name:KORYACHEK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:ST.102
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:425-232-7613
Mailing Address - Fax:
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:ST.102
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:425-232-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist