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Organization
THERASPORT NORTHWEST, INC
Active
Organization
THERASPORT NORTHWEST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEAN DAVID EVANS JR. PT (OWNER/PRESIDENT)
(509) 484-0095
Entity
Organization
Contact information
Practice address
124 E ROWAN AVE, SUITE 202, SPOKANE, WA 99207-1214
(509) 484-0095
(509) 484-0477
Mailing address
124 E ROWAN AVE, SUITE 202, SPOKANE, WA 99207-1214
(509) 484-0095
(509) 484-0477
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00002905
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104041458
INDIVIDUAL PROVIDER NPI
WA
01
—
17438
LABOR & INDUSTRIES
WA
05
—
7100431
—
WA
Enumeration date
04/29/2008
Last updated
04/29/2008
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