Provider Demographics
NPI:1992755805
Name:ADVANTAGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:509-326-7311
Mailing Address - Street 1:101 W CATALDO AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3200
Mailing Address - Country:US
Mailing Address - Phone:509-326-7311
Mailing Address - Fax:509-326-7314
Practice Address - Street 1:101 W CATALDO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3200
Practice Address - Country:US
Practice Address - Phone:509-326-7311
Practice Address - Fax:509-326-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7080112Medicaid
WA8801912Medicare ID - Type UnspecifiedKELLI J SCHUERMAN
WA7080112Medicaid
WAAB13990Medicare ID - Type UnspecifiedTIFFANY L JENSON
WAAB00185Medicare ID - Type UnspecifiedSTEPHEN R WEINBERGER