Basic Information
| Provider Information | |||||||||
| NPI: | 1770794471 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INSPIRE PHYSICAL & HAND THERAPY SPOKANE INC. P.S. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INSPIRE PHYSICAL & HAND THERAPY SPOKANE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DENNIS ST SW STE B | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985016523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603380181 | ||||||||
| FaxNumber: | 3603380257 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W 5TH AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096242353 | ||||||||
| FaxNumber: | 3603380257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | PROVOZNIK | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3603380181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | CN2416 | 01 | WA | RAILROAD MEDICARE | OTHER | GAB25145 | 01 | WA | PTAN | OTHER | 7680325 | 05 | WA | MEDICAID |