Healthcare Provider Details

I. General information

NPI: 1023899739
Provider Name (Legal Business Name): HARBOR HOME THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 96TH ST E
TACOMA WA
98446-4611
US

IV. Provider business mailing address

4209 96TH ST E
TACOMA WA
98446-4611
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-9662
  • Fax:
Mailing address:
  • Phone: 402-721-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J KUBIK
Title or Position: MEMBER
Credential: PT
Phone: 402-721-9662