Provider Demographics
NPI:1346476827
Name:REID, DANA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:REID
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4200 6TH AVE SE STE 203
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1042
Mailing Address - Country:US
Mailing Address - Phone:360-455-4448
Mailing Address - Fax:
Practice Address - Street 1:2964 LIMITED LN NW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4577
Practice Address - Country:US
Practice Address - Phone:360-704-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112923Medicaid
WA7112923Medicaid