NPI 1790458495 · live from the CMS NPI Registry
Jack Raymond Albert
Specialist/Technologist, Athletic Trainer in Spokane Valley, WA. National Provider Identifier 1790458495, active.
NPI record
| NPI | 1790458495 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Specialist/Technologist, Athletic Trainer 2255A2300X |
| Practice location | 15909 E Marietta Ave Ste 110, Spokane Valley, WA 99216 |
| Practice phone | 509-936-7466 |
| Mailing address | 207 Physical Education Building, Eastern Washington University, Cheney, WA 99004 |
| Enumerated | July 28, 2021 |
| Last updated | June 5, 2025 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapist | 225100000X | PT.PT.70004362 (WA) |
| Specialist/Technologist, Athletic Trainer primary | 2255A2300X | ATHL.A1.70008337 (WA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.