Healthcare Provider Details

I. General information

NPI: 1073418000
Provider Name (Legal Business Name): MARAT MALYSHEV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44831 MILESTONE SQ APT 443
ASHBURN VA
20147-4225
US

IV. Provider business mailing address

44831 MILESTONE SQ APT 443
ASHBURN VA
20147-4225
US

V. Phone/Fax

Practice location:
  • Phone: 301-920-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: