Provider Demographics
NPI:1316962343
Name:BESTICK, MARK E (PT, CHT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BESTICK
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N ARGONNE RD
Mailing Address - Street 2:STE.203
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2699
Mailing Address - Country:US
Mailing Address - Phone:509-444-5678
Mailing Address - Fax:509-343-5678
Practice Address - Street 1:1101 N ARGONNE RD
Practice Address - Street 2:STE.203
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2699
Practice Address - Country:US
Practice Address - Phone:509-444-5678
Practice Address - Fax:509-343-5678
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335457Medicaid
WA8850660Medicare UPIN