Liberty Lake Family & Sports Medicine, P.S.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

601991291 Issued in WA

Legal business name

LIBERTY LAKE FAMILY & SPORTS MEDICINE, P.S.

Practice address

2207 N Molter Rd
Ste 101
Liberty Lake, WA 99019-7571

Phone

(509) 921-7755

NPI assigned

Sep 25, 2007

Last updated

Oct 4, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy Manson

Title

Owner

Phone

(509) 921-7755

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317686400000",
    "number": "1043407935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD",
            "address_2": "STE 101",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD",
            "address_2": "STE 101",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197571",
            "telephone_number": "509-921-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY LAKE FAMILY & SPORTS MEDICINE, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2011-10-04",
        "status": "A",
        "authorized_official_last_name": "MANSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-921-7755"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "601991291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liberty Chiropractic LLC (Liberty Chiropractic)
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• Liberty Lake Couple and Family Therapy, LLC (Liberty Lake Couple and Family Therapy)
• Liberty Lake Direct Primary Care PLLC (Liberty Lake DPC)
• Liberty Lake Eyecare Center PS
• Liberty Lake Family Dentistry
• Liberty Lake Foot & Ankle PLLC
• Liberty Lake Medical Supply
• Liberty Lake Medical Supply, LLC
• Lilac Family Eye Care, PLLC (Lilac Family Eye Care)

• Sports Medicine (Family Medicine) Physician in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Sports Medicine (Family Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.