Jack Raymond Albert
Individual provider Active NPI Athletic Trainer · Spokane Valley, WA
NPI 1790458495 · NPPES record last updated Jun 5, 2025
Key facts
- NPI
- 1790458495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- ATHL.A1.70008337 (WA)
- Practice address
- 15909 E Marietta Ave Ste 110
Spokane Valley, WA 99216-1888 - Phone
- (509) 936-7466
- NPI assigned
- Jul 28, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT.PT.70004362 | WA | MD | Physical Therapist |
| ATHL.A1.70008337 | WA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT.PT.70004362 | WA | |
| Athletic Trainer |
2255A2300X | ATHL.A1.70008337 | WA | Yes |
Addresses
Primary practice location
15909 E Marietta Ave Ste 110
Spokane Valley, WA 99216-1888
Mailing address
207 Physical Education Building
Eastern Washington University
Cheney, WA 99004-2476
Phone (509) 359-6399
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- Teresa Lynn Albion
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All providers in Spokane Valley, WA · Athletic Trainer in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.