Provider Demographics
NPI:1265255681
Name:SPITZENBERGER, PHOEBE BRINKLEY (LMT)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:BRINKLEY
Last Name:SPITZENBERGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NW GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2869
Mailing Address - Country:US
Mailing Address - Phone:509-294-5418
Mailing Address - Fax:
Practice Address - Street 1:116 E 3RD ST STE 201212
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4318
Practice Address - Country:US
Practice Address - Phone:509-294-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4731225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist