Provider Demographics
NPI:1801124961
Name:PNEUBACK SPORTS & THERAPY INSTITUTE NORTHWEST LLC
Entity type:Organization
Organization Name:PNEUBACK SPORTS & THERAPY INSTITUTE NORTHWEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-343-3150
Mailing Address - Street 1:1421 N MULLAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4051
Mailing Address - Country:US
Mailing Address - Phone:509-343-3150
Mailing Address - Fax:866-332-9903
Practice Address - Street 1:1421 N MULLAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4051
Practice Address - Country:US
Practice Address - Phone:509-343-3150
Practice Address - Fax:866-332-9903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PNEUBACK SPORT & THERAPY INSTITUTE NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-01
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740264142OtherNPI
R112008Medicare PIN
WA1740264142OtherNPI