Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P160454748 | WA |
NPI | 1013301902 |
---|---|
Provider Name | Calysta Phillippi |
First Address | Spokane Valley, WA 99037-9363 |
Second Address | Spokane, WA 99207-5164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 27/03/2015 |