Healthcare Provider Details

I. General information

NPI: 1245392000
Provider Name (Legal Business Name): PHYSICAL MEDICINE AND REHABILITATION NORTHWEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE SUITE 200
SPOKANE WA
99204-2302
US

IV. Provider business mailing address

105 W 8TH AVE SUITE 200
SPOKANE WA
99204-2302
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-9112
  • Fax: 509-624-1087
Mailing address:
  • Phone: 509-624-9112
  • Fax: 509-624-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA S BLISS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 509-624-9112