Provider Demographics
NPI:1114990918
Name:CRONIN, BRIAN M (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:CRONIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2045
Mailing Address - Country:US
Mailing Address - Phone:509-458-7686
Mailing Address - Fax:509-458-6611
Practice Address - Street 1:125 S COWLEY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-458-7686
Practice Address - Fax:509-458-6611
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8393373Medicaid
WA8802521Medicare ID - Type Unspecified