Healthcare Provider Details

I. General information

NPI: 1457433922
Provider Name (Legal Business Name): PARKSIDE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W NORTH RIVER DR SUITE 510
SPOKANE WA
99201-2284
US

IV. Provider business mailing address

201 W NORTH RIVER DR SUITE 510
SPOKANE WA
99201-2284
US

V. Phone/Fax

Practice location:
  • Phone: 509-323-0066
  • Fax: 509-323-0067
Mailing address:
  • Phone: 509-323-0066
  • Fax: 509-323-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00009180
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00002713
License Number StateWA

VIII. Authorized Official

Name: MRS. CAROL LEE REYNOLDS
Title or Position: OWNER/OFFICE MANAGER
Credential:
Phone: 509-323-0066