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General NPI Number Information
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NPI Number | 1841388618
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Entity Type | Organization
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Legal Business Name | PEAK SPORTS & SPINE PHYSICAL THERAPY-RENTON, P.S.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 451 DUVALL AVE NE SUITE 200
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City | RENTON
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State | WA
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Zip | 98059-4675
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Country | US
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Telephone | 425-235-9505
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Fax | 425-226-7334
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Provider Business Mailing Address
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Address Line | 451 DUVALL AVE NE SUITE #200
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City | RENTON
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State | WA
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Zip | 98059
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Country | US
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Telephone | 425-235-9505
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Fax | 425-226-7334
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | RUSSELL KOWALINSKI
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Credential | PT, DPT, SCS
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Telephone | 425-235-9505
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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 |
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License Number State |
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