Provider Demographics
NPI:1811175268
Name:NORTHWEST THERAPY RESOURCES, P.S.
Entity type:Organization
Organization Name:NORTHWEST THERAPY RESOURCES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ODREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:509-921-7818
Mailing Address - Street 1:11915 E BROADWAY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4997
Mailing Address - Country:US
Mailing Address - Phone:509-921-7818
Mailing Address - Fax:509-891-0456
Practice Address - Street 1:11915 E BROADWAY AVE
Practice Address - Street 2:STE 100
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4997
Practice Address - Country:US
Practice Address - Phone:509-921-7818
Practice Address - Fax:509-891-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873482OtherPTAN