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General NPI Number Information
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NPI Number | 1104582865
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Entity Type | Individual
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Provider Name | TYESE-ANDREYA A CHUMOV LMT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 16201 E INDIANA AVE STE 1111
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-2838
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Country | US
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Telephone | 509-927-8997
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Fax | 509-927-3919
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Provider Business Mailing Address
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Address Line | 4127 E HARTSON AVE # 99202
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City | SPOKANE
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State | WA
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Zip | 99202-5111
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Country | US
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Telephone | 509-991-7229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 61214687
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License Number State | WA
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