Healthcare Provider Details

I. General information

NPI: 1356413280
Provider Name (Legal Business Name): JET CITY ENTERPRISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11304 8TH AVE NE SUITE A
SEATTLE WA
98125-6111
US

IV. Provider business mailing address

11304 8TH AVE NE SUITE A
SEATTLE WA
98125-6111
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-6184
  • Fax: 206-363-6543
Mailing address:
  • Phone: 206-363-6184
  • Fax: 206-363-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number602779150
License Number StateWA

VIII. Authorized Official

Name: NANCY J ROWLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 206-363-6184