Provider Demographics
NPI:1457433922
Name:PARKSIDE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PARKSIDE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-323-0066
Mailing Address - Street 1:201 W NORTH RIVER DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2284
Mailing Address - Country:US
Mailing Address - Phone:509-323-0066
Mailing Address - Fax:509-323-0067
Practice Address - Street 1:201 W NORTH RIVER DR
Practice Address - Street 2:SUITE 510
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2284
Practice Address - Country:US
Practice Address - Phone:509-323-0066
Practice Address - Fax:509-323-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002713261QP2000X
WAPT00009180261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7131550Medicaid
WA7131550Medicaid
WAG8858720Medicare ID - Type UnspecifiedMEDICARE OUT-PATIENT PT