Provider Demographics
NPI:1033321179
Name:WILEY, MAYA ALANA (DPT)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:ALANA
Last Name:WILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 S GRAND BLVD
Mailing Address - Street 2:SUITE #102-S
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2263
Mailing Address - Country:US
Mailing Address - Phone:509-624-4200
Mailing Address - Fax:509-624-2817
Practice Address - Street 1:3017 E FRANCIS AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-2435
Practice Address - Country:US
Practice Address - Phone:509-465-9000
Practice Address - Fax:509-465-3826
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0219630OtherDEPT. OF LABOR & INDUSTRY