Provider Demographics
NPI:1811098239
Name:LARRY HAM AND ASSOCIATES PHYSICAL THERAPY PS
Entity type:Organization
Organization Name:LARRY HAM AND ASSOCIATES PHYSICAL THERAPY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLONDEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASSONKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-532-0500
Mailing Address - Street 1:3010 S SOUTHEAST BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3542
Mailing Address - Country:US
Mailing Address - Phone:509-532-0500
Mailing Address - Fax:509-532-8810
Practice Address - Street 1:3010 S SOUTHEAST BLVD STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3542
Practice Address - Country:US
Practice Address - Phone:509-532-0500
Practice Address - Fax:509-532-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000022692251X0800X
225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
603015800OtherUS DEPT OF LABOR
WA0189665OtherDEPT OF LABOR & INDUSTRY
7807634OtherAETNA
WA2009200Medicaid