Basic Information
| Provider Information | |||||||||
| NPI: | 1760634182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHISONI MENASHI | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ALLISON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSPT, DPT | ||||||||
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| OtherLastName: | GHISONI | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | ALLISON | ||||||||
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| OtherCredential: | MSPT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3649 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992203649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15412 E SPRAGUE AVE | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990378841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00010124 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.