Healthcare Provider Details

I. General information

NPI: 1326088378
Provider Name (Legal Business Name): RALAND A. JOHN CP, LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CENTRAL AVE SUITE 215 HANGER CLINIC
SPOKANE WA
99208
US

IV. Provider business mailing address

212 CENTRAL AVE SUITE 215 HANGER CLINIC
SPOKANE WA
99208
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-6401
  • Fax: 509-325-5986
Mailing address:
  • Phone: 509-326-6401
  • Fax: 509-325-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number0100000073
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS00000074
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: