Healthcare Provider Details

I. General information

NPI: 1811098239
Provider Name (Legal Business Name): LARRY HAM AND ASSOCIATES PHYSICAL THERAPY PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 S SOUTHEAST BLVD STE G
SPOKANE WA
99223-3542
US

IV. Provider business mailing address

3010 S SOUTHEAST BLVD STE G
SPOKANE WA
99223-3542
US

V. Phone/Fax

Practice location:
  • Phone: 509-532-0500
  • Fax: 509-532-8810
Mailing address:
  • Phone: 509-532-0500
  • Fax: 509-532-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00002269
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BLONDEL C ASSONKEN
Title or Position: PRESIDENT
Credential: DPT
Phone: 509-532-0500