Provider Demographics
NPI:1861737645
Name:DEVINE, LOUANNE (PTA)
Entity type:Individual
Prefix:
First Name:LOUANNE
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 DODSON RD N
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-9712
Mailing Address - Country:US
Mailing Address - Phone:509-750-2915
Mailing Address - Fax:
Practice Address - Street 1:10435 DODSON RD N
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-9712
Practice Address - Country:US
Practice Address - Phone:509-750-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60169013225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant