Healthcare Provider Details

I. General information

NPI: 1124266671
Provider Name (Legal Business Name): PULLMAN REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 SE SUMMIT CT
PULLMAN WA
99163-5540
US

IV. Provider business mailing address

1620 SE SUMMIT CT
PULLMAN WA
99163-5540
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-5106
  • Fax: 509-334-5723
Mailing address:
  • Phone: 509-332-5106
  • Fax: 509-334-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberMA60049092
License Number StateWA

VIII. Authorized Official

Name: LEANNE LEEDY
Title or Position: MASSAGE PRACTITIONER
Credential: LMP
Phone: 907-694-2844