Provider Demographics
NPI:1720449978
Name:PECK, NATALIYA GUREVICH (LMT)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:GUREVICH
Last Name:PECK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NATALIYA
Other - Middle Name:IGOREVNA
Other - Last Name:GUREVICH-PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:92-960 HUNEKAI PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1519
Mailing Address - Country:US
Mailing Address - Phone:808-673-8276
Mailing Address - Fax:
Practice Address - Street 1:92-960 HUNEKAI PL
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1519
Practice Address - Country:US
Practice Address - Phone:808-673-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT11861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI15705317OtherCAQH