Provider Demographics
NPI:1194722728
Name:MEARS, ILISE DEVINE (PT)
Entity type:Individual
Prefix:
First Name:ILISE
Middle Name:DEVINE
Last Name:MEARS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ILISE
Other - Middle Name:
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10208 N DIVISION ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1570
Mailing Address - Country:US
Mailing Address - Phone:509-465-5400
Mailing Address - Fax:509-465-5401
Practice Address - Street 1:10208 N DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1570
Practice Address - Country:US
Practice Address - Phone:509-465-5400
Practice Address - Fax:509-465-5401
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3359225100000X
WAPT00010344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86059251885711A007OtherTRICARE
AZ86059251885711A007OtherTRICARE