Provider Demographics
NPI:1407933609
Name:INLAND PHYSICAL THERAPY AND SPORTS REHAB
Entity Type:Organization
Organization Name:INLAND PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-927-9450
Mailing Address - Street 1:606 N PINES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6706
Mailing Address - Country:US
Mailing Address - Phone:509-927-9450
Mailing Address - Fax:927-928-8574
Practice Address - Street 1:606 N PINES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6706
Practice Address - Country:US
Practice Address - Phone:509-927-9450
Practice Address - Fax:927-928-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA465OtherGROUP HEALTH
WA7011729Medicaid
WA97428OtherLABOR & INDUSTRIES
WAGAB12052Medicare PIN