Healthcare Provider Details

I. General information

NPI: 1962485821
Provider Name (Legal Business Name): STACEY ELAINE RICHARDS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY ELAINE BETTCHER

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N EVERGREEN RD SUITE 010
SPOKANE VALLEY WA
99216-1485
US

IV. Provider business mailing address

11481 SW HALL BLVD STE 201
PORTLAND OR
97223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-5367
  • Fax: 509-928-5508
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: