Provider Demographics
NPI:1689358434
Name:SHAFER, ELIJHA E
Entity Type:Individual
Prefix:
First Name:ELIJHA
Middle Name:E
Last Name:SHAFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 S SOUTHEAST BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-7415
Mailing Address - Country:US
Mailing Address - Phone:509-418-8974
Mailing Address - Fax:
Practice Address - Street 1:2339 S SOUTHEAST BLVD APT 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-7415
Practice Address - Country:US
Practice Address - Phone:509-418-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61269011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist