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Organization
LIBERTY LAKE FAMILY & SPORTS MEDICINE, P.S.
Active
Organization
LIBERTY LAKE FAMILY & SPORTS MEDICINE, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MANSON (OWNER)
(509) 921-7755
Entity
Organization
Contact information
Practice address
2207 N MOLTER RD, STE 101, LIBERTY LAKE, WA 99019-7571
(509) 921-7755
Mailing address
2207 N MOLTER RD, STE 101, LIBERTY LAKE, WA 99019-7571
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
601991291
WA
Other
Enumeration date
09/25/2007
Last updated
10/04/2011
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