Healthcare Provider Details

I. General information

NPI: 1558536615
Provider Name (Legal Business Name): RANDY L LINDSEY PT AT C INC PS COLVILLE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390351 HWY 20
CUSICK WA
99119
US

IV. Provider business mailing address

217 E 2ND AVE
COLVILLE WA
99114-2903
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-5027
  • Fax: 509-684-1033
Mailing address:
  • Phone: 509-684-5027
  • Fax: 509-684-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. RANDY L LINDSEY
Title or Position: OWNER
Credential: P,T., A.T., C.
Phone: 509-684-5027