Provider Demographics
NPI:1962079756
Name:BOWDITCH, CHARISSA K (DPT)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:K
Last Name:BOWDITCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:K
Other - Last Name:OMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 E WESTVIEW CT STE A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1376
Mailing Address - Country:US
Mailing Address - Phone:509-465-1749
Mailing Address - Fax:509-465-1748
Practice Address - Street 1:10511 W AERO RD STE 1
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-7035
Practice Address - Country:US
Practice Address - Phone:509-413-2140
Practice Address - Fax:509-413-2141
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61137628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist