Provider Demographics
NPI:1558417998
Name:NORTH SPOKANE PHYSICAL AND SPORTS THERAPY LLC
Entity Type:Organization
Organization Name:NORTH SPOKANE PHYSICAL AND SPORTS THERAPY LLC
Other - Org Name:MOMENTUM PHYSICAL THERAPY & INDUSTRIAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-535-6050
Mailing Address - Street 1:4305 E TRENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1347
Mailing Address - Country:US
Mailing Address - Phone:509-535-6050
Mailing Address - Fax:509-535-6051
Practice Address - Street 1:4305 E TRENT AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1347
Practice Address - Country:US
Practice Address - Phone:509-535-6050
Practice Address - Fax:509-535-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001080224Z00000X
WAPT00002878225100000X
WAOT00001598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA191213OtherLABOR AND INDUSTRIES
WA3565STOtherASURIS
WA7121254Medicaid
WA7121254Medicaid
WAG8800296Medicare PIN