=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154987980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROWPHYSIO PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2019
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19442 1ST AVE NE
-----------------------------------------------------
City | POULSBO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98370-7382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-363-2227
-----------------------------------------------------
Fax | 619-354-1789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19442 1ST AVE NE
-----------------------------------------------------
City | POULSBO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98370-7382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-363-2227
-----------------------------------------------------
Fax | 619-354-1789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | DR. GREGORY SPOONER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 619-363-2227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------