Healthcare Provider Details

I. General information

NPI: 1518921154
Provider Name (Legal Business Name): STACIE C SCHREIBEIS P.T.A., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACIE C. VISSER

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 E BROADWAY AVE 101
SPOKANE VALLEY WA
99206-4997
US

IV. Provider business mailing address

11915 E BROADWAY AVE 101
SPOKANE VALLEY WA
99206-4997
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-9404
  • Fax: 509-228-9403
Mailing address:
  • Phone: 509-228-9404
  • Fax: 509-228-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160045502
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-2497
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: