Provider Demographics
NPI:1407253867
Name:MARK J PIERCE
Entity Type:Organization
Organization Name:MARK J PIERCE
Other - Org Name:BRIDLE TRAILS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:425-889-0776
Mailing Address - Street 1:13120 NE 70TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8570
Mailing Address - Country:US
Mailing Address - Phone:425-889-0776
Mailing Address - Fax:425-889-0857
Practice Address - Street 1:13120 NE 70TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8570
Practice Address - Country:US
Practice Address - Phone:425-889-0776
Practice Address - Fax:425-889-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602471099261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy