Provider Demographics
NPI:1609119320
Name:OSBORNE, DAVID (ATC, LMP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:ATC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 SE BISHOP BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5414
Mailing Address - Country:US
Mailing Address - Phone:509-432-6506
Mailing Address - Fax:
Practice Address - Street 1:1256 SE BISHOP BLVD STE J
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5414
Practice Address - Country:US
Practice Address - Phone:509-432-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1602927322255A2300X
WAMA00020101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer