Basic Information
| Provider Information | |||||||||
| NPI: | 1518923457 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKE'S REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9920 N FIRCREST CT | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992089456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094756189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUTCHISON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | RECREATION THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5094756189 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CTRS/R | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | RE 00000261 | WA | Y | Hospitals | Rehabilitation Hospital |
ID Information
| ID | Type | State | Issuer | Description | RE00000261 | 01 | WA | STATE REGISTRATION | OTHER | 47471 | 01 | WA | NATIONAL CERTIFICATION | OTHER |