Healthcare Provider Details

I. General information

NPI: 1730781782
Provider Name (Legal Business Name): CROSSFIT SPOKANE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E MISSION AVE
SPOKANE WA
99202-1816
US

IV. Provider business mailing address

123 E MISSION AVE
SPOKANE WA
99202-1816
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-3198
  • Fax:
Mailing address:
  • Phone: 509-328-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGELA M GERRY
Title or Position: OWNER
Credential:
Phone: 509-209-7218