Provider Demographics
NPI:1700841129
Name:PAGET, MARK EA (PTA,ATC,CSCS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EA
Last Name:PAGET
Suffix:
Gender:M
Credentials:PTA,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:711 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1330
Mailing Address - Country:US
Mailing Address - Phone:509-473-6000
Mailing Address - Fax:509-473-5998
Practice Address - Street 1:1414 N HOUK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1097
Practice Address - Country:US
Practice Address - Phone:509-473-5494
Practice Address - Fax:509-473-5998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer