Provider Demographics
NPI:1487811394
Name:INSPIRE PHYSICAL & HAND THERAPY SPOKANE INC. P.S.
Entity type:Organization
Organization Name:INSPIRE PHYSICAL & HAND THERAPY SPOKANE INC. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVOZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-338-0181
Mailing Address - Street 1:12121 E BROADWAY AVE
Mailing Address - Street 2:BLDG. 6
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-922-5156
Mailing Address - Fax:
Practice Address - Street 1:12410 E SINTO AVE STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-922-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004122332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7680325Medicaid
WA0546580001Medicare NSC
WAAB25145Medicare PIN