Healthcare Provider Details

I. General information

NPI: 1821373572
Provider Name (Legal Business Name): LILIYA LYEBYEDYEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15220 SE 272ND ST STE D
KENT WA
98042-4241
US

IV. Provider business mailing address

26024 162ND AVE SE
COVINGTON WA
98042-8275
US

V. Phone/Fax

Practice location:
  • Phone: 206-235-6545
  • Fax: 253-631-4786
Mailing address:
  • Phone: 206-235-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60065263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: