1023187168 NPI number — PAUL D ROSENBAUM BS DPT

Table of content: PAUL D ROSENBAUM BS DPT (NPI 1023187168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023187168 NPI number — PAUL D ROSENBAUM BS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBAUM
Provider First Name:
PAUL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1023187168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1403 S GRAND BLVD
Provider Second Line Business Mailing Address:
STE 102S
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99203-2272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-465-9000
Provider Business Mailing Address Fax Number:
509-465-3826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 S UNIVERSITY RD
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-5364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-893-0600
Provider Business Practice Location Address Fax Number:
509-926-5828
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00009088 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8362741 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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