Provider Demographics
NPI:1508804105
Name:NORTHWEST MEDICAL REHABILITATION
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:509-624-0908
Mailing Address - Street 1:1315 N DIVISION ST STE A
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:509-624-0908
Mailing Address - Fax:509-459-0881
Practice Address - Street 1:1315 N DIVISION ST STE A
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:509-624-0908
Practice Address - Fax:509-459-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082035Medicaid
WA319212300Medicare ID - Type UnspecifiedGROUP NUMBER