MR. ANDREI VLADIMIROVICH MITSOUROV (NPI# 1205104775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205104775 |
| Entity Type | Individual |
| Full Name | MR. ANDREI VLADIMIROVICH MITSOUROV |
| Credential | LMP |
| Practice Address |
53387 W Crockett Rd Milton Freewater OR 97862-7941 |
| Practice Telephone | 5095401665 |
| Mailing Telephone | 5095401665 |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MA 60230518 | WA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
53387 W CROCKETT RD |
| City | MILTON FREEWATER |
| State | OR |
| Zip Code | 97862-7941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528538352 | Paksupim Cole | Massage Therapist | 85452 Hwy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1356812192 | Lacey Elizabeth Rose Klem | Massage Therapist | 85458 Hywy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1770778664 | Amon Chiropractic LLC | Chiropractor | 85458 Hwy 11, Milton Freewater, OR 97862 | 2007-09-13 |
| 1215001052 | Broadway Family Dental Care LLC | Dentist | 508 E Broadway, Milton Freewater, OR 97862 | 2006-11-20 |
| 1750462917 | Sarah S Hsu | Social Worker | 1253 Stonewood Ct, Milton Freewater, OR 97862 | 2006-10-17 |
| 1548890916 | Divine Mansiba Maganto | Nurse's Aide | 1010 Ne 3rd Ave, Milton Freewater, OR 97862 | 2020-01-24 |
| 1902317621 | Michael David Bruno | Speech-Language Pathologist | 120 Elzora St, Milton Freewater, OR 97862 | 2017-10-20 |
| 1821475286 | Danielle Strickland | Massage Therapist | 533 S Main St, Milton Freewater, OR 97862-1017 | 2015-05-05 |
| 1457476392 | Alicia A Taylor | Registered Nurse | 110 Sw 4th Ave, Milton Freewater, OR 97862-1031 | 2007-03-20 |
| 1225401151 | Serenity Counseling PC | Community/Behavioral Health | 1253 Stonewood Ct, Milton Freewater, OR 97862-1067 | 2015-10-30 |
| Find all providers in zip 97862 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528538352 | Paksupim Cole | Massage Therapist | 85452 Hwy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1356812192 | Lacey Elizabeth Rose Klem | Massage Therapist | 85458 Hywy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1376863399 | Tawnya Lynn Lage | Massage Therapist | 84709 Ringer Rd, Milton Freewater, OR 97862-6943 | 2010-06-02 |
| 1821475286 | Danielle Strickland | Massage Therapist | 533 S Main St, Milton Freewater, OR 97862-1017 | 2015-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013712 | Gabriel Henriques | Massage Therapist | 805 Se Peacock Ln, Portland, OR 97214-3278 | 2020-11-07 |
| 1871193490 | Heather R Anderson | Massage Therapist | 1646 Se Tenino St, Portland, OR 97202-6713 | 2020-11-01 |
| 1770183048 | Anna Schenk | Massage Therapist | 497 Sw Century Dr Ste 105, Bend, OR 97702-1167 | 2020-10-27 |
| 1205435716 | Michella Onnis | Massage Therapist | 2410 Se 10th Ave, Portland, OR 97214-4624 | 2020-10-26 |
| 1194324269 | Puanani Reid | Massage Therapist | 280 E Hersey St Ste B17, Ashland, OR 97520-1293 | 2020-10-20 |
| 1720686488 | Olivia Berryessa | Massage Therapist | 709 N Phoenix Rd, Medford, OR 97504-9488 | 2020-10-15 |
| 1548868466 | Massage Central LLC | Massage Therapist | 119 S Calapooia St, Sutherlin, OR 97479-8545 | 2020-10-13 |
| 1396343182 | Loretta K Bliss | Massage Therapist | 1635 Chemawa Rd Ne, Keizer, OR 97303-3639 | 2020-10-13 |
| 1982202149 | Hannah J Hamel | Massage Therapist | 1816 Cal Young Rd Apt 102, Eugene, OR 97401-2019 | 2020-10-11 |
| 1003414269 | Carlee Nicole Demore | Massage Therapist | 56880 Venture Ln # 215s, Sunriver, OR 97707-2158 | 2020-10-10 |
| Find all providers with the same taxonomy | ||||
| City | MILTON FREEWATER |
| Zip Code | 97862 |
Please comment or provide details below to improve the information on MR. ANDREI VLADIMIROVICH MITSOUROV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.