MEDICARE: LARRY HAM AND ASSOCIATES PHYSICAL THERAPY PS

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	2251X0800X	Orthopedic Physical Therapist	PT00002269	WA
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	603015800	OTHER		US DEPT OF LABOR
2	0189665	OTHER	WA	DEPT OF LABOR & INDUSTRY
3	7807634	OTHER		AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811098239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY HAM AND ASSOCIATES PHYSICAL THERAPY PS

Provider Business Mailing Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Provider Business Practice Location Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BLONDEL C ASSONKEN
Credential	:	DPT
Telephone Number	:	509-532-0500

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/22/2021

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