Healthcare Provider Details

I. General information

NPI: 1962202093
Provider Name (Legal Business Name): SAM LAWRENCE COBB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

633 W GLASS AVE # B
SPOKANE WA
99205-2962
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone: 509-936-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61669709
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: