Healthcare Provider Details

I. General information

NPI: 1790397974
Provider Name (Legal Business Name): CAPSTONE HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24118 BOTHELL EVERETT HWY UNIT 400
BOTHELL WA
98021-9379
US

IV. Provider business mailing address

8862 BENDER RD STE 101
LYNDEN WA
98264-8800
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-1115
  • Fax: 360-354-0321
Mailing address:
  • Phone: 360-255-7876
  • Fax: 360-216-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEANNETT PENNER
Title or Position: DPT/OWNER
Credential: DPT
Phone: 360-255-7876