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General NPI Number Information
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NPI Number | 1326048364
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Entity Type | Organization
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Legal Business Name | RENTON SPORTS & SPINE PT
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 19400 108TH AVE SE SUITE 100
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City | KENT
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State | WA
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Zip | 98031-0108
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Country | US
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Telephone | 425-917-9885
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Fax | 253-277-0737
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Provider Business Mailing Address
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Address Line | 19400 108TH AVE SE SUITE 100
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City | KENT
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State | WA
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Zip | 98031-0108
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Country | US
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Telephone | 425-917-9885
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Fax | 253-277-0737
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CLINCI DIRECTOR
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Name | MR. JOEL M JOHNSON
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Credential | PT
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Telephone | 425-917-9885
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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 | PT00002862
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License Number State | WA
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