=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013107549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENT PHYSICAL THERAPY & SPORTS PERFORMANCE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2205 WALL ST
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98201-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-512-8695
-----------------------------------------------------
Fax | 425-512-8697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2205 WALL ST
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98201-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-512-8695
-----------------------------------------------------
Fax | 425-512-8697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT HAMRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-512-8695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT00008062
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------