Provider Demographics
NPI:1952730152
Name:PRICE, ANDREW (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:JOHN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:3120 S GRAND BLVD UNIT 8473
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2681
Mailing Address - Country:US
Mailing Address - Phone:509-315-5561
Mailing Address - Fax:509-847-1117
Practice Address - Street 1:915 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2119
Practice Address - Country:US
Practice Address - Phone:509-413-2790
Practice Address - Fax:509-847-1117
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60285037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist