Healthcare Provider Details

I. General information

NPI: 1376071878
Provider Name (Legal Business Name): JONATHAN SCOTT ALLRED DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2017
Last Update Date: 05/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 112
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

605 E HOLLAND AVE STE 112
SPOKANE WA
99218-1246
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-5083
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: