Provider Demographics
NPI:1407043037
Name:SPOKANE SPORTS AND PHYSICAL THERAPY, PS
Entity Type:Organization
Organization Name:SPOKANE SPORTS AND PHYSICAL THERAPY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-483-0889
Mailing Address - Street 1:9631 N NEVADA ST
Mailing Address - Street 2:STE LL2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1133
Mailing Address - Country:US
Mailing Address - Phone:509-483-0889
Mailing Address - Fax:
Practice Address - Street 1:9631 N NEVADA ST
Practice Address - Street 2:STE LL2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1133
Practice Address - Country:US
Practice Address - Phone:509-483-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3886547Medicaid
WAS35181Medicare UPIN
WAAB38958Medicare PIN