MEDICARE: PHOEBE DUKE ATC, AT/L

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
1	2255A2300X	Athletic Trainer	A160050264	WA

General Provider Information

NPI Number	:	1871002477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOEBE DUKE ATC, AT/L

Provider Business Mailing Address
First Line	:	403 E 22ND AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 W FORT GEORGE WRIGHT DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5204
Country	:	US
Telephone Number	:	509-533-3640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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