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General NPI Number Information
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NPI Number | 1396150835
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Entity Type | Organization
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Legal Business Name | SOUND BALANCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 15719 63RD STREET CT E #1
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City | SUMNER
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State | WA
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Zip | 98390-3067
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Country | US
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Telephone | 253-217-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 15719 63RD STREET CT E #1
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City | SUMNER
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State | WA
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Zip | 98390-3067
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Country | US
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Telephone | 253-217-0832
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADAM JEFFREY SCHETSELAAR
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Credential | PT
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Telephone | 253-217-0832
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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 | PT60391158
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License Number State | WA
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