Healthcare Provider Details

I. General information

NPI: 1427857317
Provider Name (Legal Business Name): ANGELO R ROBOWEITRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANGELO R FLORES-CORK

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 E 57TH AVE STE H
SPOKANE WA
99223-7040
US

IV. Provider business mailing address

117 4TH ST
CHENEY WA
99004-1515
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-9398
  • Fax:
Mailing address:
  • Phone: 406-431-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61642349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: