MEDICARE: LINDSEY JOHANNA MASIAREK MPT

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	PT00009398	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0186071	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447219167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY JOHANNA MASIAREK MPT

Provider Business Mailing Address
First Line	:	6827 N DOUGLASS ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-3700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 E WESTVIEW CT
Second Line	:	SUITE A
City	:	SPOKANE
State	:	WA
Zip	:	99218-1376
Country	:	US
Telephone Number	:	509-465-1749
Fax Number	:	509-465-1748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/09/2007

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