Provider Demographics
NPI:1285748798
Name:STILES, PAULA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MARIE
Last Name:STILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21675 E MILL RIVER LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7696
Mailing Address - Country:US
Mailing Address - Phone:509-990-4583
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 100A
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7601
Practice Address - Country:US
Practice Address - Phone:509-990-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1678225100000X
WAPT00008225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0184Medicare PIN