Healthcare Provider Details

I. General information

NPI: 1790856003
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date: 11/14/2006
Reactivation Date: 11/30/2006

III. Provider practice location address

8502 N NEVADA ST #2
SPOKANE WA
99208-7395
US

IV. Provider business mailing address

8502 N NEVADA ST #2
SPOKANE WA
99208-7395
US

V. Phone/Fax

Practice location:
  • Phone: 509-487-2958
  • Fax: 509-487-3025
Mailing address:
  • Phone: 509-487-2958
  • Fax: 509-487-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name: DENNIS FITZPATRICK
Title or Position: CFO
Credential:
Phone: 610-644-7824