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General NPI Number Information
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NPI Number | 1366063778
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Entity Type | Organization
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Legal Business Name | NORTHWEST MOBILE PHYSICAL THERAPY SPECIALISTS PLLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 119 W COLUMBIA AVE
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City | SPOKANE
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State | WA
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Zip | 99205-6224
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Country | US
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Telephone | 509-294-5579
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W COLUMBIA AVE
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City | SPOKANE
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State | WA
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Zip | 99205-6224
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Country | US
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Telephone | 509-294-5579
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PT
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Name | CHARLES NICHOLS III
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Credential |
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Telephone | 509-294-5579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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