Healthcare Provider Details

I. General information

NPI: 1902018054
Provider Name (Legal Business Name): PIONEER SPORTS AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 SECOND AVENUE SUITE 100
SEATTLE WA
98104
US

IV. Provider business mailing address

506 SECOND AVENUE SUITE 100
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-264-9780
  • Fax:
Mailing address:
  • Phone: 206-264-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID J LEFFMANN
Title or Position: OWNER
Credential: MPT
Phone: 206-264-9780