1700841129 NPI number — MR. MARK E.A. PAGET PTA,ATC,CSCS

Table of content: MR. MARK E.A. PAGET PTA,ATC,CSCS (NPI 1700841129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700841129 NPI number — MR. MARK E.A. PAGET PTA,ATC,CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGET
Provider First Name:
MARK
Provider Middle Name:
E.A.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PTA,ATC,CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700841129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 S COWLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99202-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-473-6000
Provider Business Mailing Address Fax Number:
509-473-5998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 N HOUK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-5494
Provider Business Practice Location Address Fax Number:
509-473-5998
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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