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General NPI Number Information
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NPI Number | 1740723915
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Entity Type | Organization
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Legal Business Name | PREVAIL PRACTICES, PLLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 18303 1ST AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-3529
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Country | US
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Telephone | 206-920-5372
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Fax | 866-329-2785
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Provider Business Mailing Address
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Address Line | 18303 1ST AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-3529
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Country | US
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Telephone | 206-920-5372
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | MR. KENNETH BRUK BALLENGER
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Credential | DPT, PT
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Telephone | 206-920-5372
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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 | 7473
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License Number State | WA
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