Healthcare Provider Details

I. General information

NPI: 1952196719
Provider Name (Legal Business Name): IRYNA LYSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 AUBURN WAY N STE 301
AUBURN WA
98002-1400
US

IV. Provider business mailing address

1312 M ST SE APT B
AUBURN WA
98002-6765
US

V. Phone/Fax

Practice location:
  • Phone: 253-886-5016
  • Fax: 253-886-5024
Mailing address:
  • Phone: 253-217-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61643176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: