Provider Demographics
NPI:1639473788
Name:PACE, EDWARD CHARLES (LMT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHARLES
Last Name:PACE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:EDDY
Other - Middle Name:
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4716 S SANDS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-9438
Mailing Address - Country:US
Mailing Address - Phone:360-296-4060
Mailing Address - Fax:
Practice Address - Street 1:1212 N WASHINGTON ST STE 108
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2401
Practice Address - Country:US
Practice Address - Phone:360-296-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60125268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist