Basic Information
| Provider Information | |||||||||
| NPI: | 1245364439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKSIDE PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W NORTH RIVER DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093230066 | ||||||||
| FaxNumber: | 5093230067 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W NORTH RIVER DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093230066 | ||||||||
| FaxNumber: | 5093230067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5093230066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0205712 | 01 | WA | LABOR AND INDUSTRIES # | OTHER | 7131550 | 05 | WA | MEDICAID |