Organization
RUSSELL MIKAMI
Active
Other names
Lighthouse Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA MIKAMI (BUSINESS MANAGER)
(509) 928-3443
Entity
Organization
Contact information
Practice address
15413 E VALLEYWAY AVE BLDG B-200, SPOKANE VALLEY, WA 99037-8554
(509) 928-3443
Mailing address
15413 E VALLEYWAY AVE BLDG B-200, SPOKANE VALLEY, WA 99037-8554
(509) 928-3443
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT 00003614
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7107527
—
WA
Enumeration date
08/18/2010
Last updated
08/18/2010
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