Healthcare Provider Details

I. General information

NPI: 1528014875
Provider Name (Legal Business Name): BIOSPORTS NORTHWEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16007 NE 8TH ST SUITE 200
BELLEVUE WA
98008
US

IV. Provider business mailing address

16007 NE 8TH ST SUITE 200
BELLEVUE WA
98008
US

V. Phone/Fax

Practice location:
  • Phone: 425-985-8915
  • Fax:
Mailing address:
  • Phone: 425-985-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00002943
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DENIS BRYAN DICKS
Title or Position: CO OWNER
Credential:
Phone: 206-947-8050