Healthcare Provider Details

I. General information

NPI: 1285924787
Provider Name (Legal Business Name): SESE SPORTS PERFORMANCE GROUP, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 116TH AVE NE 111
BELLEVUE WA
98004-3009
US

IV. Provider business mailing address

10351 NE 10TH ST APT 907
BELLEVUE WA
98004-4645
US

V. Phone/Fax

Practice location:
  • Phone: 425-221-7253
  • Fax: 888-812-4162
Mailing address:
  • Phone: 425-221-7253
  • Fax: 888-812-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY GABRIEL SESE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 425-221-7253