1558417998 NPI number — NORTH SPOKANE PHYSICAL AND SPORTS THERAPY LLC

Table of content: (NPI 1558417998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558417998 NPI number — NORTH SPOKANE PHYSICAL AND SPORTS THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SPOKANE PHYSICAL AND SPORTS THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOMENTUM PHYSICAL THERAPY & INDUSTRIAL REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558417998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4305 E TRENT AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99212-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-535-6050
Provider Business Mailing Address Fax Number:
509-535-6051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4305 E TRENT AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-6050
Provider Business Practice Location Address Fax Number:
509-535-6051
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STROM
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
509-535-6050

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  OC00001080 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT00002878 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT00001598 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 191213 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3565ST . This is a "ASURIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7121254 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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