Provider Demographics
NPI:1326027020
Name:PARKLAND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PARKLAND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPT, ATC
Authorized Official - Phone:253-531-8595
Mailing Address - Street 1:12001 PACIFIC AVE S
Mailing Address - Street 2:#101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5101
Mailing Address - Country:US
Mailing Address - Phone:253-531-8595
Mailing Address - Fax:253-531-6607
Practice Address - Street 1:12001 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5101
Practice Address - Country:US
Practice Address - Phone:253-531-8595
Practice Address - Fax:253-531-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000080632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113327Medicaid
WA7113327Medicaid