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General NPI Number Information
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NPI Number | 1285718015
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Entity Type | Organization
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Legal Business Name | BELLEVUE SPORTS & SPINE PHYSICAL THERAPY PS
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 1975 112TH AVE NE STE 100
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City | BELLEVUE
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State | WA
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Zip | 98004-2942
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Country | US
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Telephone | 425-450-9801
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Fax | 425-450-9778
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Provider Business Mailing Address
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Address Line | 1605 116TH AVE NE SUITE 110
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City | BELLEVUE
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State | WA
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Zip | 98004-3034
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Country | US
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Telephone | 425-450-9801
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Fax | 425-450-9778
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RUSSELL KOWALINSKI
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Credential | PT
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Telephone | 425-450-9801
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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 |
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License Number State | WA
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