Healthcare Provider Details

I. General information

NPI: 1396150835
Provider Name (Legal Business Name): SOUND BALANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15719 63RD STREET CT E #1
SUMNER WA
98390-3067
US

IV. Provider business mailing address

15719 63RD STREET CT E #1
SUMNER WA
98390-3067
US

V. Phone/Fax

Practice location:
  • Phone: 253-217-0832
  • Fax:
Mailing address:
  • Phone: 253-217-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT60391158
License Number StateWA

VIII. Authorized Official

Name: MR. ADAM JEFFREY SCHETSELAAR
Title or Position: OWNER
Credential: PT
Phone: 253-217-0832