Provider Demographics
NPI:1700062890
Name:NKS REHAB PLLC
Entity Type:Organization
Organization Name:NKS REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNITTA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-325-1977
Mailing Address - Street 1:PO BOX 2886
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2886
Mailing Address - Country:US
Mailing Address - Phone:509-838-6060
Mailing Address - Fax:
Practice Address - Street 1:707 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2739
Practice Address - Country:US
Practice Address - Phone:509-838-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125263Medicaid
WAG8802061Medicare PIN