Healthcare Provider Details

I. General information

NPI: 1942498415
Provider Name (Legal Business Name): BRADLEY RICHARD OLMSTEAD LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W 4TH AVE
SPOKANE WA
99201-5620
US

IV. Provider business mailing address

1625 W. 4TH AVE
SPOKANE WA
99201
US

V. Phone/Fax

Practice location:
  • Phone: 509-496-3493
  • Fax: 509-838-5779
Mailing address:
  • Phone: 509-496-3493
  • Fax: 509-838-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: