Healthcare Provider Details

I. General information

NPI: 1447047477
Provider Name (Legal Business Name): EVERETT PHYSICAL THERAPY AND SPORT PERFORMANCE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22910 BOTHELL EVERETT HWY STE 107
BOTHELL WA
98021-9327
US

IV. Provider business mailing address

22910 BOTHELL EVERETT HWY STE 107
BOTHELL WA
98021-9327
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-7656
  • Fax:
Mailing address:
  • Phone: 425-686-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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: RICHARD BINSTEIN
Title or Position: EVP
Credential:
Phone: 713-297-7000