Basic Information
| Provider Information | |||||||||
| NPI: | 1700841129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGET | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E.A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA,ATC,CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736000 | ||||||||
| FaxNumber: | 5094735998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1414 N HOUK RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992161097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094735494 | ||||||||
| FaxNumber: | 5094735998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 2255A2300X | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.