Provider Demographics
NPI:1679697981
Name:TRIBER, SHAWN RENEE (PT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RENEE
Last Name:TRIBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12708 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0524
Mailing Address - Country:US
Mailing Address - Phone:509-315-5711
Mailing Address - Fax:509-443-4170
Practice Address - Street 1:2510 N PINES RD STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-315-5711
Practice Address - Fax:509-443-4170
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
WAPT00003512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7098619Medicaid