Healthcare Provider Details

I. General information

NPI: 1992184360
Provider Name (Legal Business Name): MR. JOHN MUELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N HOUK RD SUITE 208
SPOKANE VALLEY WA
99216-1097
US

IV. Provider business mailing address

1414 N HOUK RD SUITE 208
SPOKANE VALLEY WA
99216-1097
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5560
  • Fax: 509-755-5561
Mailing address:
  • Phone: 509-755-5560
  • Fax: 509-755-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA1 60543430
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-502
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: