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General NPI Number Information
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NPI Number | 1396096731
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Entity Type | Organization
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Legal Business Name | JET CITY HOLDINGS, INC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 486 228TH AVE NE
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City | SAMMAMISH
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State | WA
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Zip | 98074-7209
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Country | US
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Telephone | 425-836-8444
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Fax | 425-836-8447
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Provider Business Mailing Address
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Address Line | 1482 26TH AVE NE
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City | ISSAQUAH
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State | WA
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Zip | 98029-7414
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Country | US
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Telephone | 425-503-0930
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANCE RANDALL RUNJE
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Credential |
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Telephone | 425-503-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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