Healthcare Provider Details

I. General information

NPI: 1396785937
Provider Name (Legal Business Name): BIOSPORTS NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 6TH AVE N
SEATTLE WA
98109-5005
US

IV. Provider business mailing address

215 6TH AVE N
SEATTLE WA
98109-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-956-9300
  • Fax: 206-956-9462
Mailing address:
  • Phone: 206-956-9300
  • Fax: 206-956-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00005366
License Number StateWA

VIII. Authorized Official

Name: NICHOLE SLUSSER
Title or Position: ADMINISTRATIVE DIRECTO
Credential:
Phone: 206-956-9300