Provider Demographics
NPI:1689974719
Name:PHA STAR VENTURES LLC
Entity Type:Organization
Organization Name:PHA STAR VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-473-7827
Mailing Address - Street 1:12410 E SINTO AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2199
Mailing Address - Country:US
Mailing Address - Phone:509-927-7827
Mailing Address - Fax:509-928-7556
Practice Address - Street 1:208 E FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1071
Practice Address - Country:US
Practice Address - Phone:509-489-7827
Practice Address - Fax:509-489-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty