NPIMap

Organization Active NPI

Lakeside Physical Therapy LLC

  • Physical Therapist
  • Spokane Valley, WA
National Provider Identifier
1023183142
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00007174 Issued in WA
Legal business name
LAKESIDE PHYSICAL THERAPY LLC
Practice address
1512 N Vercler Rd
Suite 1
Spokane Valley, WA 99216-1087
Phone
(509) 891-0658
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Schneider, PTNPI 1750321071
Title
Member Mnager
Phone
(509) 891-0658

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00007174 WA Primary

Addresses

Primary practice location

1512 N Vercler Rd
Suite 1
Spokane Valley, WA 99216-1087

Mailing address

PO Box 3115
Hayden, ID 83835-3115
Phone (208) 765-0805

Other identifiers 1

IdentifierTypeStateIssuer
7094345MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1023183142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3115",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838353115",
            "telephone_number": "208-765-0805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N VERCLER RD",
            "address_2": "SUITE 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161087",
            "telephone_number": "509-891-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "SCHNEIDER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MEMBER MNAGER",
        "authorized_official_telephone_number": "509-891-0658",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7094345",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.