Healthcare Provider Details

I. General information

NPI: 1497396436
Provider Name (Legal Business Name): BALL SPORTS PERFORMANCE AND PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13104 SW 220TH ST
VASHON WA
98070-6334
US

IV. Provider business mailing address

13104 SW 220TH ST
VASHON WA
98070-6334
US

V. Phone/Fax

Practice location:
  • Phone: 206-567-7740
  • Fax:
Mailing address:
  • Phone: 206-567-7740
  • 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: MICHAEL BALL
Title or Position: OWNER
Credential: MPT
Phone: 206-567-7740