Basic Information
| Provider Information | |||||||||
| NPI: | 1063522928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAARSPUL | ||||||||
| FirstName: | BEN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NE MOTHER JOSEPH PL | ||||||||
| Address2: | STE 210 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602546161 | ||||||||
| FaxNumber: | 3604491146 | ||||||||
| Practice Location | |||||||||
| Address1: | 1812 N LAKEWOOD DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089664476 | ||||||||
| FaxNumber: | 2089664475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5223 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-7564 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1063522928 | 05 | ID | MEDICAID |