Provider Demographics
NPI:1730219692
Name:WASHINGTON OUTPATIENT REHABILITATION, LLC
Entity type:Organization
Organization Name:WASHINGTON OUTPATIENT REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-242-6002
Mailing Address - Street 1:507 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2608
Mailing Address - Country:US
Mailing Address - Phone:509-242-6002
Mailing Address - Fax:509-624-5061
Practice Address - Street 1:507 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2608
Practice Address - Country:US
Practice Address - Phone:509-242-6002
Practice Address - Fax:509-624-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008982208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115090Medicaid
WAGAB34093Medicare ID - Type Unspecified