=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346753860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUDMILA MOSKVICH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 11/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12914 SE 273RD PL APT 16
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98030-8935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-245-8505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12914 SE 273RD PL APT 16
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98030-8935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-245-8505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 60763152
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------