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NPI Code Detail

MEDICARE: PINE LAKE PHYSICAL THERAPY & SPORTS REHAB, P.S.

MEDICARE: PINE LAKE PHYSICAL THERAPY & SPORTS REHAB, P.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical TherapistPT00003047WA

General Provider Information

NPI Number : 1356471684
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE LAKE PHYSICAL THERAPY & SPORTS REHAB, P.S.
Provider Business Mailing Address
First Line : 2850 228TH AVE SE
Second Line : SUITE B
City : SAMMAMISH
State : WA
Zip : 98075-9301
Country : US
Telephone Number : 425-391-4488
Fax Number : 425-391-8287
Provider Business Practice Location Address
First Line : 2850 228TH AVE SE
Second Line : SUITE B
City : SAMMAMISH
State : WA
Zip : 98075-9301
Country : US
Telephone Number : 425-391-4488
Fax Number : 425-391-8287
Authorized Official
Title or Position : OWNER
Name : MR. RONALD DEAN ENYEART
Credential : P.T.
Telephone Number : 425-391-4488
Provider Enumeration Date : 03/06/2007
Last Update Date : 03/19/2009

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Directions to “PINE LAKE PHYSICAL THERAPY & SPORTS REHAB, P.S. ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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