Provider Demographics
NPI:1427497106
Name:INSPIRE PHYSICAL THERAPY, INC., P.S.
Entity type:Organization
Organization Name:INSPIRE PHYSICAL THERAPY, INC., P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROVOZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-338-0181
Mailing Address - Street 1:100 DENNIS ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:4740 AVERY LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5603
Practice Address - Country:US
Practice Address - Phone:360-491-1815
Practice Address - Fax:360-491-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty