Provider Demographics
NPI:1821609249
Name:KINGSFORD PHYSICAL THERAPY AND WELLNESS PLLC
Entity Type:Organization
Organization Name:KINGSFORD PHYSICAL THERAPY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRAIDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-598-9402
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0072
Mailing Address - Country:US
Mailing Address - Phone:509-598-9402
Mailing Address - Fax:
Practice Address - Street 1:2207 N MOLTER RD STE 203
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7571
Practice Address - Country:US
Practice Address - Phone:509-598-9402
Practice Address - Fax:509-436-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy