Healthcare Provider Details

I. General information

NPI: 1245177682
Provider Name (Legal Business Name): TRAILSIDE PHYSICAL THERAPY AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 MAIN ST NE STE A3
DUVALL WA
98019-8443
US

IV. Provider business mailing address

PO BOX 565
DUVALL WA
98019-0565
US

V. Phone/Fax

Practice location:
  • Phone: 602-799-6848
  • Fax:
Mailing address:
  • Phone: 602-799-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC BERNARD MARIE
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 602-799-6848