Provider Demographics
NPI:1548480205
Name:PAGOTELIS, ALEX NICHOLAS (MS, PT)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:NICHOLAS
Last Name:PAGOTELIS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 E VISTA PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9447
Mailing Address - Country:US
Mailing Address - Phone:509-892-7435
Mailing Address - Fax:
Practice Address - Street 1:3151 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4800
Practice Address - Country:US
Practice Address - Phone:509-532-0500
Practice Address - Fax:509-532-8810
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00433694OtherRAILROAD MEDICARE
WA220594OtherWA L&I
WA220594OtherWA L&I