Healthcare Provider Details

I. General information

NPI: 1700466083
Provider Name (Legal Business Name): KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 BARBER CUT OFF RD NE STE C1
KINGSTON WA
98346-8484
US

IV. Provider business mailing address

2400 NW MYHRE RD STE 101
SILVERDALE WA
98383-7672
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-7050
  • Fax: 360-598-3282
Mailing address:
  • Phone: 360-598-3764
  • Fax: 360-598-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SUMMER ZUMWALT
Title or Position: HRD
Credential:
Phone: 360-598-3764