Provider Demographics
NPI:1922071455
Name:CREEKSIDE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:CREEKSIDE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-952-3134
Mailing Address - Street 1:4205 CASTLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-5603
Mailing Address - Country:US
Mailing Address - Phone:509-576-0100
Mailing Address - Fax:509-576-0101
Practice Address - Street 1:4205 CASTLEVALE RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-5603
Practice Address - Country:US
Practice Address - Phone:509-576-0100
Practice Address - Fax:509-576-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA800489OtherHARFFORD LIFE INSURANCE
WA7123987Medicaid
WA0200730OtherLABOR AND INDUSTRIES
WA106263300OtherOFFICE OF WORKERS COMP
WA8940288OtherCRIME VICTIMS
WA7123987Medicaid
WA8940288OtherCRIME VICTIMS