Provider Demographics
NPI:1699983882
Name:POLISHUK, RICHARD MICHAEL (LMP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:POLISHUK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NE 194TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2135
Mailing Address - Country:US
Mailing Address - Phone:206-409-2435
Mailing Address - Fax:206-708-6210
Practice Address - Street 1:4000 AURORA AVE N STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7853
Practice Address - Country:US
Practice Address - Phone:206-409-2435
Practice Address - Fax:206-708-6210
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00005538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist