Provider Demographics
NPI:1578679767
Name:GREATER SPOKANE THERAPIES
Entity Type:Organization
Organization Name:GREATER SPOKANE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:STAUDENRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-991-5678
Mailing Address - Street 1:PO BOX 48583
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228
Mailing Address - Country:US
Mailing Address - Phone:509-991-5655
Mailing Address - Fax:509-328-7802
Practice Address - Street 1:W 13011 SHORE ROAD
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026
Practice Address - Country:US
Practice Address - Phone:509-991-5678
Practice Address - Fax:509-328-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL0606367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB22689Medicare ID - Type Unspecified