Healthcare Provider Details

I. General information

NPI: 1700748886
Provider Name (Legal Business Name): VLADYSLAV YAVYTSIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 S KIRKWOOD RD APT 912
HOUSTON TX
77077-6152
US

IV. Provider business mailing address

2277 S KIRKWOOD RD APT 912
HOUSTON TX
77077-6152
US

V. Phone/Fax

Practice location:
  • Phone: 832-480-3578
  • Fax:
Mailing address:
  • Phone: 832-480-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT145140
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: