Healthcare Provider Details

I. General information

NPI: 1508102989
Provider Name (Legal Business Name): EVERETT PHYSICAL THERAPY & SPORTSPERFORMANCE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 07/21/2022
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 116TH AVE NE SUITE 101
BELLEVUE WA
98004-3010
US

IV. Provider business mailing address

13425 SE 30TH ST STE 2C
BELLEVUE WA
98005-4450
US

V. Phone/Fax

Practice location:
  • Phone: 425-628-2072
  • Fax: 425-341-9056
Mailing address:
  • Phone: 425-628-2072
  • Fax: 425-341-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP/AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7052