Healthcare Provider Details

I. General information

NPI: 1376850370
Provider Name (Legal Business Name): KATERYNA VOLODYMYRIVNA BAKAY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2010
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 S RAVENCREST DR
SPOKANE WA
99224-5329
US

IV. Provider business mailing address

5616 S RAVENCREST DR
SPOKANE WA
99224-5329
US

V. Phone/Fax

Practice location:
  • Phone: 918-688-4403
  • Fax:
Mailing address:
  • Phone: 918-688-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT60184214
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: