Provider Demographics
NPI:1699099796
Name:KRUKOVETS, ZHANNA (LMP)
Entity type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:KRUKOVETS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14595 BEL RED RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3950
Mailing Address - Country:US
Mailing Address - Phone:425-401-6513
Mailing Address - Fax:425-401-2004
Practice Address - Street 1:14595 BEL RED RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3950
Practice Address - Country:US
Practice Address - Phone:425-401-6513
Practice Address - Fax:425-401-2004
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60024999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist