Provider Demographics
NPI:1184891723
Name:PETRIE, MOLLY RUTH (LMP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RUTH
Last Name:PETRIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:RUTH
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2808
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2800
Mailing Address - Country:US
Mailing Address - Phone:509-688-6702
Mailing Address - Fax:509-688-6792
Practice Address - Street 1:3010 S SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3541
Practice Address - Country:US
Practice Address - Phone:509-533-1000
Practice Address - Fax:509-533-1838
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154414761OtherCOLUMBIA MEDICAL ASSOCIATES GROUP NPI NUMBER