Healthcare Provider Details

I. General information

NPI: 1033023213
Provider Name (Legal Business Name): NOAH SANDBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 W RIO GRANDE AVE BLDG B
KENNEWICK WA
99336-2623
US

IV. Provider business mailing address

3304 S TWEEDT ST
KENNEWICK WA
99337-2776
US

V. Phone/Fax

Practice location:
  • Phone: 509-460-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70167478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: