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Organization
MOSES LAKE SPORTS PHYSICAL THERAPY, PS
Active
Organization
MOSES LAKE SPORTS PHYSICAL THERAPY, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY C BRUCE MSPT (PHYSICAL THERAPIST)
(509) 766-4277
Entity
Organization
Contact information
Practice address
515 N STRATFORD RD, MOSES LAKE, WA 98837-1572
(509) 766-4277
(509) 766-4280
Mailing address
515 N STRATFORD RD, MOSES LAKE, WA 98837-1572
(509) 766-4277
(509) 766-4280
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005408
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193527700
OWCP
WA
01
—
51945
WORK HARDENING
WA
05
—
7062011
—
WA
Enumeration date
03/20/2007
Last updated
04/30/2008
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