Provider Demographics
NPI:1003956327
Name:SPINK, ANN LARSON (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LARSON
Last Name:SPINK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3226
Mailing Address - Country:US
Mailing Address - Phone:360-757-9335
Mailing Address - Fax:360-757-9886
Practice Address - Street 1:1838 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-757-9335
Practice Address - Fax:360-757-9886
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103400600OtherU.S. DEPT OF LABOR (OWCP)
WA0157498OtherLABOR & INDUSTRIES
WA8752SPOtherPREMERA BLUE CROSS
WA650017406OtherRAILROAD MEDICARE
WA8752SPOtherREGENCE BLUE SHIELD
WAGAB27113Medicare ID - Type Unspecified