Healthcare Provider Details

I. General information

NPI: 1194857250
Provider Name (Legal Business Name): LAKELAND SPORTS & SPINE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 LAKE TAPPS PKWY E SUITE E106
AUBURN WA
98092-8158
US

IV. Provider business mailing address

1408 LAKE TAPPS PKWY E SUITE E106
AUBURN WA
98092-8158
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-7179
  • Fax: 253-939-7182
Mailing address:
  • Phone: 253-939-7179
  • Fax: 253-939-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: PAMELA LOUISE WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 253-939-7179