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General NPI Number Information
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NPI Number | 1962645002
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Entity Type | Individual
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Provider Name | LISA NICOLE EVERETT DPT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2009
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 15412 E SPRAGUE AVE SUITE 8
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8841
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Country | US
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Telephone | 509-838-2531
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 3649
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City | SPOKANE
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State | WA
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Zip | 99220-3649
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Country | US
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Telephone | 509-838-2531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00010612
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License Number State | WA
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