Healthcare Provider Details

I. General information

NPI: 1225372915
Provider Name (Legal Business Name): PHYSICAL THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S GRAND BLVD
SPOKANE WA
99203-2560
US

IV. Provider business mailing address

3020 S GRAND BLVD
SPOKANE WA
99203-2560
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-6917
  • Fax:
Mailing address:
  • Phone: 509-456-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number208100000X
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number19320000X
License Number StateWA

VIII. Authorized Official

Name: KELLY RISSE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential:
Phone: 509-456-6917