Healthcare Provider Details

I. General information

NPI: 1578147062
Provider Name (Legal Business Name): APEX KINETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 PACIFIC AVE
TACOMA WA
98402-5209
US

IV. Provider business mailing address

15916 93RD AVE E
PUYALLUP WA
98375-6718
US

V. Phone/Fax

Practice location:
  • Phone: 253-215-6100
  • Fax:
Mailing address:
  • Phone: 120-638-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN LEE VANDENBOSCH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 206-519-0135