Healthcare Provider Details

I. General information

NPI: 1497640924
Provider Name (Legal Business Name): NORTHWEST SPORTS AND EXERCISE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N HAMILTON ST
SPOKANE WA
99202-2045
US

IV. Provider business mailing address

730 N HAMILTON ST
SPOKANE WA
99202-2045
US

V. Phone/Fax

Practice location:
  • Phone: 509-703-7866
  • Fax: 506-703-7868
Mailing address:
  • Phone: 509-703-7866
  • Fax: 506-703-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FRALICH
Title or Position: OWNER
Credential: MD
Phone: 509-703-7866