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General NPI Number Information
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NPI Number | 1588280804
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Entity Type | Organization
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Legal Business Name | RAINIER FAMILY AND SPORTS MEDICINE P C
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 16202 64TH ST E STE 104
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City | SUMNER
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State | WA
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Zip | 98390-3028
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Country | US
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Telephone | 253-987-7754
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Fax | 253-987-7049
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Provider Business Mailing Address
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Address Line | 1402 LAKE TAPPS PKWY SE STE F104 #133
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City | SUMNER
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State | WA
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Zip | 98390
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Country | US
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Telephone | 253-987-7754
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Fax | 253-987-7049
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. KENT R WALKER
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Credential | DO
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Telephone | 253-987-7754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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