Healthcare Provider Details

I. General information

NPI: 1295649648
Provider Name (Legal Business Name): ELITE PERFORMANCE SPORTS WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21915 6TH AVE W
BOTHELL WA
98021-8137
US

IV. Provider business mailing address

21915 6TH AVE W
BOTHELL WA
98021-8137
US

V. Phone/Fax

Practice location:
  • Phone: 909-969-8716
  • Fax:
Mailing address:
  • Phone: 909-969-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JERIMIAH JOSEPH SEEDS-MURPHY
Title or Position: OWNER, PT
Credential: DPT
Phone: 909-969-8716