Provider Demographics
NPI:1235151986
Name:RANDY L LINDSEY PT AT C INC PS
Entity Type:Organization
Organization Name:RANDY L LINDSEY PT AT C INC PS
Other - Org Name:COLVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-991-1326
Mailing Address - Street 1:217 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2903
Mailing Address - Country:US
Mailing Address - Phone:509-684-5027
Mailing Address - Fax:509-684-6133
Practice Address - Street 1:217 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2903
Practice Address - Country:US
Practice Address - Phone:509-684-5027
Practice Address - Fax:509-684-6133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDY L LINDSEY PT AT C INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0178076OtherL&I
WA1235151986Medicaid
WA7096936Medicaid