Healthcare Provider Details

I. General information

NPI: 1073810222
Provider Name (Legal Business Name): CHAMPIONS SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
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: 509-487-4467
  • Fax: 509-487-4503
Mailing address:
  • Phone: 509-487-4467
  • Fax: 509-487-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD00019290
License Number StateWA

VIII. Authorized Official

Name: DR. PATRICK Z PEARCE
Title or Position: OWNER/PHYSICIAN
Credential: M.D.,
Phone: 509-891-1291