Healthcare Provider Details

I. General information

NPI: 1083195820
Provider Name (Legal Business Name): KAIZEN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 01/20/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE STE 201
SEATTLE WA
98105-4152
US

IV. Provider business mailing address

5808 123RD PL SE
SNOHOMISH WA
98296-8900
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. COLIN MARTIN SISCO
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT, OCS
Phone: 206-524-6702