Dmitriy Andrushchenko, AS

Individual provider Active NPI Physical Therapy Assistant · Federal Way, WA

NPI 1003280322 · NPPES record last updated Nov 24, 2015

Key facts

NPI
1003280322
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
P160505759 (WA)
Practice address
33625 27TH PL SW
Federal Way, WA 98023-7711
Phone
(253) 569-2957
NPI assigned
Nov 24, 2015
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Associate of Science

State licenses

LicenseStateTypeSpecialty
P160505759WAMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X P160505759 WA Yes

Addresses

Primary practice location

33625 27TH PL SW
Federal Way, WA 98023-7711

Mailing address

33625 27TH PL SW
Federal Way, WA 98023-7711
Phone (253) 569-2957

Other providers in Federal Way, WA

All providers in Federal Way, WA · Physical Therapy Assistant in Washington

Sources for this page

Verify at the official NPI Registry.