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General NPI Number Information
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NPI Number | 1881010817
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Entity Type | Individual
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Provider Name | DANIIL DOVGOPOLYY
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Gender | Male
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 620 HAZEL ST
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City | ARLINGTON
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State | WA
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Zip | 98223-8245
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Country | US
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Telephone | 360-403-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 224 B 98TH PL SE
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City | EVERETT
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State | WA
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Zip | 98208
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Country | US
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Telephone | 425-773-5849
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1 60433007
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License Number State | WA
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