Healthcare Provider Details

I. General information

NPI: 1932888518
Provider Name (Legal Business Name): SEATTLE SPORTS CHIROPRACTIC & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 E MARGINAL WAY S STE C120
SEATTLE WA
98134-2328
US

IV. Provider business mailing address

4634 E MARGINAL WAY S STE C120
SEATTLE WA
98134-2328
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-7943
  • Fax: 206-932-8686
Mailing address:
  • Phone: 206-932-7943
  • Fax: 206-932-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: TIM CLOTHIER
Title or Position: OWNER
Credential:
Phone: 206-419-2790