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General NPI Number Information
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NPI Number | 1891748323
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Entity Type | Organization
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Legal Business Name | SPOKANE SPORTS AND SPINE PLLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 507 S WASHINGTON ST SUITE 10
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City | SPOKANE
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State | WA
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Zip | 99204-2604
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Country | US
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Telephone | 509-242-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 507 S WASHINGTON ST SUITE 10
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City | SPOKANE
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State | WA
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Zip | 99204-2604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOHN F LONG
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Credential | DO
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Telephone | 509-242-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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