MEDICARE: MRS. YULIYA LUTSKOV MA60040556

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA60040556	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710037874	OTHER		CHIROPRACTIC

General Provider Information

NPI Number	:	1720624257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YULIYA LUTSKOV MA60040556

Provider Business Mailing Address
First Line	:	7404 EVERGREEN WAY STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-5683
Country	:	US
Telephone Number	:	425-382-2188
Fax Number	:	888-741-1274

Provider Business Practice Location Address
First Line	:	7404 EVERGREEN WAY STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-5683
Country	:	US
Telephone Number	:	425-382-2188
Fax Number	:	888-741-1274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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