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General NPI Number Information
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NPI Number | 1093210759
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Entity Type | Organization
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Legal Business Name | URBAN FITNESS AND HEALTH CLUB LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 525 E COLLEGE WAY
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City | MOUNT VERNON
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State | WA
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Zip | 98273-5571
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Country | US
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Telephone | 206-999-9310
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Fax |
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Provider Business Mailing Address
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Address Line | 21802 37TH PL W
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City | BRIER
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State | WA
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Zip | 98036-8090
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Country | US
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Telephone | 206-999-9310
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DON CLARK LABOURR
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Credential | PT
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Telephone | 206-999-9310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00002005
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License Number State | WA
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