Provider Demographics
NPI:1023187168
Name:ROSENBAUM, PAUL D (DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 E SINTO AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2258
Mailing Address - Country:US
Mailing Address - Phone:509-789-2956
Mailing Address - Fax:509-789-2976
Practice Address - Street 1:12410 E SINTO AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2258
Practice Address - Country:US
Practice Address - Phone:509-789-2956
Practice Address - Fax:509-789-2976
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8362741Medicaid
WA8362741Medicaid