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General NPI Number Information
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NPI Number | 1205249323
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Entity Type | Organization
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Legal Business Name | BODY WELLNESS PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 2340 130TH AVE NE BLDG D - SUITE 200
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City | BELLEVUE
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State | WA
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Zip | 98005-1700
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Country | US
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Telephone | 425-305-0576
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Fax |
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Provider Business Mailing Address
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Address Line | 12653 93RD PL NE
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City | KIRKLAND
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State | WA
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Zip | 98034-5911
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Country | US
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Telephone | 425-305-0576
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. LYUDMILA VAKHNENKO
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Credential | PT, DPT
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Telephone | 425-305-0576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 60219395
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License Number State | WA
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