Healthcare Provider Details

I. General information

NPI: 1013107549
Provider Name (Legal Business Name): KENT PHYSICAL THERAPY & SPORTS PERFORMANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 WALL ST
EVERETT WA
98201-3761
US

IV. Provider business mailing address

2205 WALL ST
EVERETT WA
98201-3761
US

V. Phone/Fax

Practice location:
  • Phone: 425-512-8695
  • Fax: 425-512-8697
Mailing address:
  • Phone: 425-512-8695
  • Fax: 425-512-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00008062
License Number StateWA

VIII. Authorized Official

Name: ROBERT HAMRE
Title or Position: OWNER
Credential:
Phone: 425-512-8695