Provider Demographics
NPI:1194894220
Name:SCHWENDIMAN, BRYCE E (MPT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:E
Last Name:SCHWENDIMAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 S GRAND BLVD
Mailing Address - Street 2:STE 102S
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2272
Mailing Address - Country:US
Mailing Address - Phone:509-659-5408
Mailing Address - Fax:509-659-1252
Practice Address - Street 1:1403 S GRAND BLVD
Practice Address - Street 2:SUITE #102-S
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2263
Practice Address - Country:US
Practice Address - Phone:509-624-4200
Practice Address - Fax:509-624-2817
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8343659Medicaid
WA8343659Medicaid