Provider Demographics
NPI:1275745663
Name:PAGE, COERY D (LMT)
Entity Type:Individual
Prefix:MR
First Name:COERY
Middle Name:D
Last Name:PAGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1231
Mailing Address - Country:US
Mailing Address - Phone:509-483-8688
Mailing Address - Fax:
Practice Address - Street 1:2320 N ATLANTIC ST
Practice Address - Street 2:103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4811
Practice Address - Country:US
Practice Address - Phone:509-327-8306
Practice Address - Fax:509-327-8306
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA16662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist