Healthcare Provider Details

I. General information

NPI: 1790416170
Provider Name (Legal Business Name): NATALIYA ZAGORODNYAYA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 S MARKET BLVD
CHEHALIS WA
98532-3041
US

IV. Provider business mailing address

381 S MARKET BLVD
CHEHALIS WA
98532-3041
US

V. Phone/Fax

Practice location:
  • Phone: 541-852-9770
  • Fax:
Mailing address:
  • Phone: 254-202-5210
  • Fax: 360-242-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61220860
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: