Provider Demographics
NPI:1275140279
Name:PAVLENKO, MARINA (DPT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PAVLENKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:KOBYLNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:920 NE 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5114
Mailing Address - Country:US
Mailing Address - Phone:360-567-2002
Mailing Address - Fax:360-567-2005
Practice Address - Street 1:110 110TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5840
Practice Address - Country:US
Practice Address - Phone:425-628-2072
Practice Address - Fax:425-341-9056
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61098335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist