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MR. ANDREI VLADIMIROVICH MITSOUROV LMP
NPI 1205104775
Massage Therapist in Milton Freewater, OR

Active since December 12, 2011
53387 W CROCKETT RD, MILTON FREEWATER, OR 97862(509) 540-1665 Get Directions Write a Review

NPPES record last updated: December 12, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Andrei Vladimirovich Mitsourov Lmp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. ANDREI VLADIMIROVICH MITSOUROV LMP (NPI 1205104775) is an individual massage therapist in Milton Freewater, Oregon, licensed in Washington (MA 60230518) and active in the NPI registry since December 2011.

NPPES Registry Identity

NPI1205104775
Entity TypeIndividualMale
Primary Taxonomy225700000X
Provider Legal NameMR. ANDREI VLADIMIROVICH MITSOUROVCredential: LMP
Location Address53387 W CROCKETT RDMilton Freewater, OR 97862-7941
Mailing Address53387 W Crockett RdMilton Freewater, OR 97862-7941 · (509) 540-1665
Phone(509) 540-1665
Sole ProprietorYes
Enumeration DateDecember 12, 2011
✔ NPI 1205104775 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225700000X
License✔ Licensed in WA · MA 60230518
Definition
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.
53387 W CROCKETT RD, Milton Freewater, OR 97862
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrei Mitsourov's NPI number?

The NPI number for Andrei Mitsourov is 1205104775. It was assigned to this individual provider in the NPPES registry on December 12, 2011.

Where is Andrei Mitsourov located?

Andrei Mitsourov practices at 53387 W Crockett Rd, Milton Freewater, OR 97862. The listed phone number is (509) 540-1665.

What is Andrei Mitsourov's specialty?

The primary specialty registered for this NPI is Massage Therapist with taxonomy code 225700000X.

When was this NPI record last updated?

The NPPES record for Andrei Mitsourov was last updated on December 12, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.