Healthcare Provider Details

I. General information

NPI: 1619229168
Provider Name (Legal Business Name): PROFESSIONAL ANALYTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

IV. Provider business mailing address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-5460
  • Fax: 509-473-5760
Mailing address:
  • Phone: 509-473-5460
  • Fax: 509-473-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM REHWALD
Title or Position: CFO
Credential:
Phone: 509-473-5460