Provider Demographics
NPI:1225504004
Name:AXTELL, VERA JANELLE
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:JANELLE
Last Name:AXTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398A HAPPY HILL RD
Mailing Address - Street 2:
Mailing Address - City:TUMTUM
Mailing Address - State:WA
Mailing Address - Zip Code:99034-9702
Mailing Address - Country:US
Mailing Address - Phone:509-953-6223
Mailing Address - Fax:
Practice Address - Street 1:15407 E MISSION AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8527
Practice Address - Country:US
Practice Address - Phone:509-928-3111
Practice Address - Fax:509-928-7662
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160293901225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty