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NPI Code Detail

MEDICARE: GRASSROOTS OF SPOKANE LLC

MEDICARE: GRASSROOTS OF SPOKANE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistWA

General Provider Information

NPI Number : 1376871657
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRASSROOTS OF SPOKANE LLC
Provider Business Mailing Address
First Line : 1303 S GRAND BLVD
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1136
Country : US
Telephone Number : 509-474-0213
Fax Number : 509-315-8354
Provider Business Practice Location Address
First Line : 1303 S GRAND BLVD
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1136
Country : US
Telephone Number : 509-474-0213
Fax Number : 509-315-8354
Authorized Official
Title or Position : BILLING MANAGER
Name : FELISHA D PEDERSON
Credential :
Telephone Number : 509-315-5561
Provider Enumeration Date : 11/25/2009
Last Update Date : 11/25/2009

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Directions to “GRASSROOTS OF SPOKANE LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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