Healthcare Provider Details

I. General information

NPI: 1932559549
Provider Name (Legal Business Name): ZACHARY RUZISKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SW 356TH ST
FEDERAL WAY WA
98023-3033
US

IV. Provider business mailing address

737 1ST AVE E
PACIFIC WA
98047-1226
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-1441
  • Fax:
Mailing address:
  • Phone: 253-205-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60104731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: