Healthcare Provider Details

I. General information

NPI: 1720969520
Provider Name (Legal Business Name): LILIYA J KUZUBOVA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22048 102ND PL SE
KENT WA
98031-9500
US

IV. Provider business mailing address

22048 102ND PL SE
KENT WA
98031-9500
US

V. Phone/Fax

Practice location:
  • Phone: 206-334-3278
  • Fax:
Mailing address:
  • Phone: 206-334-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP161120719
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: