Provider Demographics
NPI:1184919458
Name:POOSRI, RUNGROY
Entity type:Individual
Prefix:
First Name:RUNGROY
Middle Name:
Last Name:POOSRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 W KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4326
Mailing Address - Country:US
Mailing Address - Phone:509-496-8711
Mailing Address - Fax:
Practice Address - Street 1:1427 W KNOX AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4326
Practice Address - Country:US
Practice Address - Phone:509-496-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60084257173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist