Provider Demographics
NPI:1992365860
Name:FORTE THERAPY
Entity Type:Organization
Organization Name:FORTE THERAPY
Other - Org Name:FORTE THERAPY, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYRESON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, PT
Authorized Official - Phone:509-474-9197
Mailing Address - Street 1:7407 N. DIVISION STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5689
Mailing Address - Country:US
Mailing Address - Phone:509-474-9197
Mailing Address - Fax:509-443-3834
Practice Address - Street 1:7407 N. DIVISION STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5689
Practice Address - Country:US
Practice Address - Phone:509-474-9197
Practice Address - Fax:509-443-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2140299Medicaid