Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00002269 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00002269 | WA |
NPI | 1083715429 |
---|---|
Provider Name | Mr. Lawrence Edward Ham |
First Address | Spokane, WA 99223-3542 |
Second Address | Spokane, WA 99223-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0189664 | DEPT OF LABOR & INDUSTRY (01) | WA |
2009197 | (05) | WA |
4531957 | AETNA (01) |