Healthcare Provider Details

I. General information

NPI: 1558528091
Provider Name (Legal Business Name): CASEY A CHECCHIO LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE SUITE 1300
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

3797 MARK RD
LOON LAKE WA
99148-9780
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-2444
  • Fax:
Mailing address:
  • Phone: 509-233-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00024781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: