Provider Demographics
NPI:1326088378
Name:JOHN, RALAND A (CP, LPO)
Entity Type:Individual
Prefix:MR
First Name:RALAND
Middle Name:A
Last Name:JOHN
Suffix:
Gender:M
Credentials:CP, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CENTRAL AVE SUITE 215
Mailing Address - Street 2:HANGER CLINIC
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-326-6401
Mailing Address - Fax:509-325-5986
Practice Address - Street 1:212 CENTRAL AVE SUITE 215
Practice Address - Street 2:HANGER CLINIC
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-326-6401
Practice Address - Fax:509-325-5986
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0100000073222Z00000X
WAPS00000074224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8418691OtherPIN NUMBER MEDICAID
WA9011495Medicaid
CP001296OtherABC NBR 033831
CP001296OtherABC NBR 033831
WA8418691OtherPIN NUMBER MEDICAID