Healthcare Provider Details

I. General information

NPI: 1376986398
Provider Name (Legal Business Name): PROGRESSIVE TRUCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

11915 E BROADWAY AVE STE 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 TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHY MOREAU
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-228-9404