Provider Demographics
NPI:1972366839
Name:ARTSIUKH, SAMUEL (LMT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ARTSIUKH
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 1:6621 ROAD E.2 NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4329
Mailing Address - Country:US
Mailing Address - Phone:864-804-7895
Mailing Address - Fax:
Practice Address - Street 1:835 E COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4617
Practice Address - Country:US
Practice Address - Phone:509-764-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61493195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist