Provider Demographics
NPI:1023187168
Name:ROSENBAUM, PAUL D (BS DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:BS DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 S GRAND BLVD
Mailing Address - Street 2:STE 102S
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2272
Mailing Address - Country:US
Mailing Address - Phone:509-465-9000
Mailing Address - Fax:509-465-3826
Practice Address - Street 1:213 S UNIVERSITY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5364
Practice Address - Country:US
Practice Address - Phone:509-893-0600
Practice Address - Fax:509-926-5828
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00009088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8362741Medicaid
WA8362741Medicaid