Provider Demographics
NPI:1306985700
Name:PHYSICAL THERAPY ASSOCIATES PS
Entity type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-456-6917
Mailing Address - Street 1:2507 E 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4908
Mailing Address - Country:US
Mailing Address - Phone:509-456-6917
Mailing Address - Fax:509-456-5902
Practice Address - Street 1:2507 E 27TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4908
Practice Address - Country:US
Practice Address - Phone:509-456-6917
Practice Address - Fax:509-456-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL0711669208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7081300Medicaid
43500OtherDLI
AB22323Medicare ID - Type Unspecified