MEDICARE: INDEPENDENT PHYSICAL THERAPY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1063585982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY ASSOCIATES

Provider Business Mailing Address
First Line	:	12525 EAST MISSION
Second Line	:	SUITE 104
City	:	SPOKANE
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

Provider Business Practice Location Address
First Line	:	12525 EAST MISSION
Second Line	:	SUITE 104
City	:	SPOKANE
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

Authorized Official
Title or Position	:	PT OWNER
Name	:	MR. DAVID W RUDNICK
Credential	:	PT
Telephone Number	:	509-928-1500

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	01/16/2015

Similar Medicare Providers

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Practice Location Address:

12525 EAST MISSION , SUITE 104
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1902293756 — MS. CAROLINE MARIE STUART PA-C, MPAS, ATC
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