Provider Demographics
NPI:1063585982
Name:INDEPENDENT PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-928-1500
Mailing Address - Street 1:12525 EAST MISSION
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1079
Mailing Address - Country:US
Mailing Address - Phone:509-928-1500
Mailing Address - Fax:509-928-8006
Practice Address - Street 1:12525 EAST MISSION
Practice Address - Street 2:SUITE 104
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216-1079
Practice Address - Country:US
Practice Address - Phone:509-928-1500
Practice Address - Fax:509-928-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty