Provider Demographics
NPI:1649254947
Name:MCREYNOLDS, PAIGE L (PT)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:L
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-755-6580
Practice Address - Street 1:605 E HOLLAND AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2225
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7022601Medicaid
WA8345860Medicaid
WA8345860Medicaid