Provider Demographics
NPI:1477025930
Name:SPOKANE REHAB & PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:SPOKANE REHAB & PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT
Authorized Official - Phone:509-808-6265
Mailing Address - Street 1:1315 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-321-8447
Practice Address - Street 1:1315 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1899
Practice Address - Country:US
Practice Address - Phone:509-808-6265
Practice Address - Fax:509-321-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty