Healthcare Provider Details

I. General information

NPI: 1588280804
Provider Name (Legal Business Name): RAINIER FAMILY AND SPORTS MEDICINE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16202 64TH ST E STE 104
SUMNER WA
98390-3028
US

IV. Provider business mailing address

1402 LAKE TAPPS PKWY SE STE F104 #133
SUMNER WA
98390
US

V. Phone/Fax

Practice location:
  • Phone: 253-987-7754
  • Fax: 253-987-7049
Mailing address:
  • Phone: 253-987-7754
  • Fax: 253-987-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT R WALKER
Title or Position: CEO/PRESIDENT
Credential: DO
Phone: 253-987-7754