Healthcare Provider Details

I. General information

NPI: 1003272675
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: 01/12/2016
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 NE 68TH ST SUITE C
KIRKLAND WA
98033-7044
US

IV. Provider business mailing address

10600 NE 68TH ST STE C
KIRKLAND WA
98033-7044
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-1389
  • Fax: 425-820-3996
Mailing address:
  • Phone: 425-823-1389
  • Fax: 425-820-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP/AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000