Healthcare Provider Details

I. General information

NPI: 1770034837
Provider Name (Legal Business Name): PUGET SOUND HEALTH AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 SE 240TH ST STE D
KENT WA
98042-5120
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-3026
  • Fax: 253-631-3899
Mailing address:
  • Phone: 855-456-7146
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BLAINE STIMAC
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 406-756-1128